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Compulsive Gambling “Action” Inventory©

Valerie C. Lorenz, Ph.D.

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Presented at the Pre-Conference Learning Institute “Compulsive Gambling: Your Bet Your Life” at the American Counseling Association Annual Conference and Exposition, March 19-23, 2009, Charlotte, North Carolina

Compulsive Gambling “Action” Inventory©

The “Action” Inventory is a 17-Question clinical tool which explores the Thoughts, Feelings, Behaviors, and their Physical Impact on the gambler throughout one day of compulsive gambling during the end-stage of this addiction.

The Inventory was developed by Dr. Lorenz in 1995 as a research instrument, but it developed into a powerful clinical tool in helping the gambler and family members understand the depth of this psychiatric disorder.

Family members are present but remain silent while this 1-hour Inventory is administered.

Caveats – Be Informed

The clinician must be knowledgeable with all types of gambling sites, the many forms of gambling and their uniqueness in order to obtain an accurate description of events. For instance:

Lottery tickets can be $1 or $20, Pick 3, Pick 4, scratch-offs, single or multi-state, national; keno

Slots can be touch screens or one-armed bandits; fruit, eight-liners or video poker machines; usually with popular television show themes; they can be legal or “gray area” machines;

Casino gambling can be found in Las Vegas, on Native American reservations, on riverboats or at racinos;

Gambling can take place in jail, at work, home, school, on the street, over the Internet; alone, with others, by phone or mail;

Card clubs can be legal or illegal after-hours clubs; the bookie might be a neighbor or mobster;

Payment for gambling is with cash, checks, credit cards, markers and slots fun cards; money can be obtained legally or illegally

Know the difference

Introduction

The following two cases are fairly typical of a male casino gambler and a female slots player. Obviously, all interviews are unique, relating to the gambler’s own experiences and needs, and should not be viewed as representative of all gamblers.

Before and throughout the interview the clinician must encourage the gambler to give detailed responses and identify multiple feelings, while keeping the gambler focused on the question being explored. Also, the clinician must know precisely the kind of gambling and location.

If the Inventory is used as a clinical tool (not for research), the questions should be geared to the gambler’s unique- ness, thus the questions or their order may be changed as appropriate.

Instructions

“This interview is to determine how you think, feel, and act, throughout one day of gambling, from the moment you wake up until you go to bed at night. I will ask you questions from step to step.

Tell me all of your thoughts during each time period, your behaviors, your feelings, how strong each feeling is, from 1% to 100%, and in what part of your body you experience that feeling or sensation – is it in your head, stomach, back, etc. This may be difficult for you. If so, tell me at once.

Please look at the form to familiarize yourself with the questions in the Inventory. Add any feelings or sensations which may apply to you.”

The gambler is shown the form which includes a list of 30 feelings commonly associated with gambling and 17 specific questions related to the gambling. The gambler is instructed to focus on one typical day of gambling, 1 or 2 months prior to abstinence, entering a treatment program, or joining Gamblers Anonymous.

“Family members, you may find this session upsetting, but please do not ask questions or interrupt us until we are finished. We will then discuss this session in detail. Please know that your questions and comments will be helpful and will benefit both you and the gambler.”

@ means this should be explored further, now or at the end of the interview 6

Example: Male, 48, married, employed, casinos, blackjack, gambled 15 years DSM Criteria of 312.31, Section A are included as (x)

Q1. What are your First Thoughts when you wake up?

I wake up thinking I need money to gamble. I’ve gotta get to the blackjack table. I hope I win. I don’t want to lose again. I feel so anxious, tense, 95%, my head feels so empty, it’s just air. My stomach is tied in knots.

Note the physical impact due to emotional stress (6)

The night before I played for 27 hours, straight through, lost

$2.4 million and got back $2.1 million. @ I was exhausted, I went to bed for 45 minutes, but couldn’t sleep. @ My head was racing.

Stress leading to sleep disruption and deprivation

I had to go back and win, win what I lost, and win so I can gamble more.

This is known as “chasing” and magical thinking (6) 7

Q2. When do you Decide to gamble?

If I’m at home, I already know I’m going. There’s nothing to decide. All I need is the money. @

Note the irrationality of thinking and focus on money

I’ve been a high roller there for five years. @ The casino compted me for the past ten months, I had my own suite. I never had to leave. It was convenient, made me feel good, @ but after a few months I just left. I wasn’t there for the casino, just for the gambling.

Casinos offer a variety of comps to high rollers and whales, intended to keep the gambler at its casino

@ I never felt anything, I was “in the zone.” @

A descriptive term used by compulsive gamblers

Q3. How do you decide how much Money you need and how do you get this money?

I had three or four escrow accounts at different banks belonging to my clients. I would wire for a half, one time for 3.6 million.@ I was borrowing it because I knew I was getting the Big Win and could replace it.

The gambler is acknowledging thefts from clients’ escrow accounts and rationalizing the theft by referring to it as “borrowing” it. (8)

Note the escalating amounts of money and the magical thinking (2)

I was anxious, nervous (75%) that I might lose, everything was speeding up when I got closer to the casino. I would call my host @ to get my room & things ready. I had to get there as fast as possible to play.

Note the ying/yang thinking, increased stress,

and expectation of support from his host 9

Q4. Describe your Trip to the casino.

My host offered me a private jet, that felt tremendous. At first it impressed me, but then it was routine. When I got off the plane, they had a Rolls Royce waiting. We would pull up to the casino and I go right to “my table.” @ I had my own table and my own blackjack dealer. It was faster. They do anything to get me there, invite my family, give them gifts. @ The comps meant nothing to me. I tell them “just leave me alone.” I was there to gamble, not to socialize. @

These enticements for High Rollers are typical of Vegas and AC casinos “Comps” are based on the gambler’s win/loss profile

I would get the money, and gamble before they even cashed the checks. I sign a marker, @ not aware of how much money it was for. I wasn’t looking at the chips, thinking this is actually half a million. I just focused on “I have to win.”

Note the altered state of consciousness 10

Q5. What happens when you are Placing the bet or are Watching the deal?@

I get anxious. I don’t want to lose, not after the big loss at Caesar’s. I’ve gotta win.

Desperation and “Chasing” his losses (6)

When I lose, I never let the dealer or anyone else know how I feel. I’d be stressed out, my head is spinning, and I’m Mr. Cool, wear my Mask @ and keep gambling, there’s always the possibility of a good run. Once I was up 200 thousand, lost 1.2 million. I kept thinking, “I can’t believe I did that” and told the dealer that. He said, “You never know.”

Wearing “the mask” and disbelief

I started drinking @ in 2005, rum and cokes instead of lattes. Sometimes I drank too much, that made for poor decisions. The gambling got worse and so did the drinking.

Onset of possible co-addiction to alcohol 11

Q6. Do you do anything Special before you start playing?

I used to count the cards and read book after book on betting strategies. I’m good with numbers. @ I always felt confident. I developed my own system and it worked.

Compulsive gambling starts out as social gambling (1)

Compulsive gamblers are noted for extraordinary skills with numbers

In the past I would walk around, look at the tables, and go to a table with just one or two other players, more than that slows you down. I don’t care about the dealers, but the Asian women are better.

Social gambling is progressing to problem gambling

Now, when I go through those revolving doors, I become a different person. @ I’m in a rush, I go directly to “my table.” They have a guard to keep others away.

Onset of dissociation seen in compulsive gambling

Guards to protect the player adds to the “Big Shot” image 12

Q7. What do you do after you’ve Won the first few hands?

Thank you, Lady Luck, the cards are hot, I’m going on a streak, @ I can feel it. Now I can play longer. Then my bets get larger. That’s the rule, play with their money.

Superstition, magical thinking and justification

This isn’t a feeling of happiness - it’s a relief to get out of a losing streak. It lasts until the next bet. So you’re always tense, stressed (60%), ready for the fall or the hit. That’s what keeps you going, “the action”. @

This example of “being in action” suggests intermittent reinforcement

The tension mounts, you try to concentrate, play your system. And I stay at this table, it’s a winner.

Escalation of tension and irrationality

Q8. You’ve played a few hands and you’re Losing. What happens now?

My stress level gets still higher, 75%. I start thinking how I’ve messed up my life. I should stop @ before it gets worse. I get depressed, even though I knew it was coming.

A moment of rationality followed by unbearable emotional states

The world comes crashing down on me, like a jack-hammer, but I have to camouflage it, can’t let anybody know, it’s my big secret. It’s torture. @

Masking and an accurate description of impact of active compulsive gambling

Then I start looking around, ask for another dealer, or go to another table, count my chips, got to make my luck change.

An example of diagnostic criteria - the inability to stop (3)

Q9. What are your Reasons for Stopping after a full gambling session?

I don’t stop until I run out of money. I used up the ATM card. My credit cards are maxed out. No more markers. I’m such a degenerate loser. Dad @ always told me I was a loser and I would never amount to anything.

Addictions are rooted in poor relationships, i.e. an abusive family of origin (5)

I feel so hopeless, desperate, horrible (100%). My body hurts all over, for five minutes or more, and then I spend the rest of the night figuring out how to get some money, play again, and win back what I lost. @

This is a desperate attempt at “chasing” and (4)

Towards the end losing didn’t matter. When I lost that last million, I lied to my wife and left home because I didn’t want to get into a huge fight with her. If I had to choose between my wife and money, I would pick money. That’s sick.

This is not “hitting bottom” @ but rather a recognition that his behavior is “sick” 15

Q10. You have to Stop Playing for the night What’s next?

When I gamble, I’m in a trance, @ either way, winning or losing. I can’t quit.

An indication of a disassociative state and loss of control

If I have to quit I always figure out how I can stay longer. If I still have some markers, I cash in, collect the money, and check out. But I go right back to the table. @ I finally quit because I know I’m coming back tomorrow. If I’m on a losing streak at one casino, I quit and go to another one.

I tip everybody, the dealer, the cocktail waitress, valet attendant. I’ve been gambling for over ten years and winning didn’t happen very often, especially not in the end. If you lose you still tip, you can’t let anyone know that you’re broke, a loser.

It is a truism that addicts do not learn from experience

Q11. You’re going Home a Winner.

It’s in my chest, my head, the burden is taken off, my shoulders are light, it’s what I strive for every day. I feel so relieved (100%). I’m a winner.@

He is not a failure but he has proven dad wrong, he is a winner

If I drive, it’s 90 mph. I can’t get home fast enough. I’m floating (95%), life is good. If I go in the Rolls, I sleep until I get home. My wife will be happy when I show her the money, but I only give her half of it. I keep the other half for the next time.

Is this wife co-dependent or fixated on money? Holding back some of the money is typical – this is gambling money and also a control issue (7)

I feel relieved, my shoulders loosen up, I wear my mask and smile, but I know she can see through me.

At this stage many wives have given up and are relieved to receive at least some money to pay the bills

Q12. You’re going Home a Loser.

I’m mentally and physically exhausted. I feel like shit, guilt (100%), depression (98%), fear (98%), every feeling imaginable, all bad. I play it over and over in my mind, again and again. I should have played it another way, why did I do that? Why didn’t I stop? How can you be so stupid? My stomach is killing me, I’m gonna vomit, but I keep beating myself. It’s disgust with myself, anger at myself, 100%.

Compulsive gambling is a prolonged state of emotional and physical pain (1)

Then comes the “You don’t deserve them. They’re better off without me. If I crash, at least they’ll get enough insurance money for bills and to live on.”@

Having an auto accident is the most frequent form of suicide attempt, especially those who drive to distant gambling sites

I know I’m a degenerate gambler, @ but to get help? That’s a sign of weakness, being a failure.@ I can’t do it.

Q13. What happens when you get Home?

I don’t know what’s worse, the anger or the tears. When she’s angry, I’m terrified she’ll leave me. When she cries, I die of guilt. It’s a no-win for me. @

The resulting turmoil and strained relationships (9)

She yells, pleads, “Why don’t you quit?” She doesn’t get it, I want to quit, I tried so many times but I can’t.

Maybe I am crazy, maybe I belong in the looney bin. But I know I can win tomorrow. @

The attempts and inability to cut back or control gambling (3)

God, my head hurts. My shoulders and back are killing me. I can’t lift my legs. Everything’s in slow motion. What is wrong with me?@

Standing at a craps table or pulling the handle on a slot machine, poor eating habits and sleep deprivation lead to physical ailments, such as heart attacks, back problems, chronic headaches, heavy smoking

Q14. You’re in bed, what are some of your thoughts and how well do you Sleep?

Sleep? I can’t sleep. I keep thinking, “I can’t believe it. How am I gonna get some money?” What I took was just a loan, I was gonna win and put it back. I never stole in my entire life, now I’m a felon. Jail,@ oh God, my kids, my wife, my license.

Diminished capacity: knowing right from wrong but with disregard for the consequences and an inability to control behavior that is known to be unlawful (1, 8)

I’m going out of my mind. All of me hurts – my body, inside and out, I can’t focus. Why can’t I just die, just go to sleep and never wake up again? I’m so tired, so sick of being sick and tired. The gambling addict has “hit bottom”

Maybe I should get some help, but who’s going to pay for it? Insurance won’t. @ Gamblers Anonymous?@ I’m not going to some religious meeting with a bunch of sickos.@

These are common beliefs – they contain some elements of truth 20

Q15. At what point could Someone Else have stopped you from gambling again?

I don’t think anyone could have stopped me. In the end I was a robot, on automatic pilot. Hand after hand, I don’t even think. They let me sign marker after marker,@ I don’t even know for how much, just let me stay in action. I knew I was losing, I didn’t care. I lost millions.

An indication of being completely out of control, possibly a psychotic break

Stop me? Maybe my mother could have, but she died when I was a kid.@ Maybe the casinos could, but why would they? My big losses are a big win for them. If they tried, they still couldn’t stop me. I’d just go to another casino.

Compulsive gamblers experience multiple childhood traumas (5) which remain emotionally ignored and unresolved

No, nobody could have stopped me. Not even jail.

It takes several “bottoms” before reaching a final state of exhaustion 21

Q16. At what point could you have Stopped Yourself from gambling?

Stop myself? I wanted to, but I couldn’t. I tried over and over again. As long as I’m in action, there is hope. I can turn my troubles over. I can avoid everybody and escape everything. That’s pathetic. I’m intelligent, but that’s really pathetic.

Intelligence @ does not prevent poor judgment or poor health (3)

If I could have stopped myself, I would have.

Abstinence and recovery requires treatment and emotional support

Why did I stop? I couldn’t stop crying, the pain was too great, I was too exhausted. I pleaded for help and finally someone told me where I could get help and physically took me there. I couldn’t do it by myself.

Hitting bottom, giving up denial, and no longer “a loner”

Q17. Now that you have stopped, what are your intentions for the Future?

I know @ I can’t gamble anymore. I have to get a second job, to pay off my debts. I want to pay off the debts in one year, @ especially the casinos and my parents who mortgaged their house for me. They always treated me right. My wife will have to work, too. @

Parents often sacrifice all their savings to “help” the gambler (10) Abstinence without recovery Admission, expectations, delusions and demands

I’m still scared 100% all the time. What if my boss finds out about the escrow accounts and the cops come? I can’t go to jail, and I can’t afford a lawyer. @

True recovery requires rigorous honesty and correction of wrongs (8)

I don’t ever want to gamble again. No, never again. Well, maybe just once, after the debts are paid off, just for fun.

The ultimate delusion and denial

The following case is presented to point out some differences in styles, attitudes and needs from the previous gambler.

Example #2

Female, 44, married, homemaker with a part-time job, plays slots at a nearby racino. She has gambled for four years.

What are your first thoughts upon waking up?

I wake up thinking I need money to gamble. I’m going to the racino. I hope I can win. I get a sick feeling in my stomach. Then I think of the lights, the bright lights from the giant chandeliers, dazzling in my head. I know I’m going.

When do you plan to gamble?

I dress for the racino, I don’t wear my work clothes. I’ve got to hurry to catch the bus. I get anxious, What if I miss the bus? Oh, well, I’ll catch the next one. I feel tense, in my whole body.

Where do you get the money for gambling?

I go to the bank and draw out $500 or what I can. I hope I win, I feel good (60%). I hope nobody from work sees me there. I get anxious (65%) and start to get a headache.

How do you get to the racino?

I have no car, I lost my license because I couldn’t pay the insurance. So I take the bus and I’m glad I’m getting away from my husband. I don’t want to deal with him. I let others get off first, I’m not rushing or anything. Others stand in line, I sit and figure out which slots to play first.

How do you decide which machine to play?

I like the ones with the good music, it draws you in. If someone is playing “my machines,” I stand behind them until they leave. I feel good. I feel upbeat. I talk to the machines, “You’re so pretty, so colorful, you let me win.”

I always play two machines. The pit boss closes them and holds them for me if I have to go to the bathroom. It’s good anticipation, 100%. 26

What do you do when you gamble?

I slide my fun card in, one in each machine. They’re good for 1000 credits ($250). Now I can just sit and play and play. If the credits are used up and I’m broke, I look around, check the other machines, maybe I’ll find a quarter someone left behind. Or I trade in my points with someone in exchange for cash. I can always get another credit card or increase my limit. I have five now.

Watching the wheels spin

I get pulled in, like being sucked into the machine. I play the second one while the wheels are spinning on the first one. I don’t actually watch while it’s spinning, I just hit the buttons when it stops. I’m pretty good at it, I can hit them real fast. I smoke a lot now, two packs a day. I started two years ago.

When do you stop gambling and why?

I hate that, but I have to be back before my husband gets home from work. He puts me down all the time, says I’m fat, stupid and refers to me as The Liar, The Thief. In front of the kids and my friends. I hate being around him. He drove me to gambling in the first place, now he’s driving me out of the house.

How do you feel going home with money?

That’s good, I can pay a couple of bills he didn’t know about. And I have enough to go back. I feel the excitement, but what if he finds out? I don’t tell him how much, just that I broke even or won a few dollars. He knows that’s not the truth. So what?

What happens if you go home and you’ve lost?

I’m used to that. I try to hide it but he figures it out. He controls our money, so I borrow from work, use bill money, or write a check on his account. That really gets him. And I have five credit cards, he knows about one. It’s up and down, feel good, feel bad, like on a roller coaster. Sometimes I really hate him, why doesn’t he just leave me alone?

Gambling isn’t about the money, it’s to get away from it all, from life, from problems. When I play and get sucked into the machine it’s hypnotic, I feel safe, win or lose.

Who could have stopped you?

Stopped me? I thought nobody knew how bad it was, but they did. I kept thinking, Who really cares about Me? My husband, he yells and threatens me with jail. My kids tell me, “Just stop.” My mom kept asking me what did she do wrong, was it her fault? My boss threatened to fire me. Who could have stopped me? Nobody.

If they couldn’t, when could you have stopped yourself?

I couldn’t. Oh, I tried, over and over again. I knew I was losing, and that bad things were happening and would get worse, but I didn’t care and besides, I couldn’t stop. It’s like a magnet, it just pulls you in.

I tried to stop with a bottle of pills and got my stomach pumped. That’s when somebody from Gamblers Anonymous came to the house. It helped, but it wasn’t enough. @ And you, you’re my husband, you don’t even go to GamAnon.@ 30

A Review of the ‘Action’ Inventory©

The Inventory ideally is administered when the family is actively involved in the gambler’s treatment

Family members should participate in sessions before and after administration of the Inventory.

The Inventory becomes part of the treatment relapse prevention strategies.

The Inventory should be administered by licensed clinical mental health counselors.

Administration of the Inventory must be consistent when it is used as a research instrument.

The Inventory© must be accurately referenced in all administrations and writings.

A copy of the Inventory is attached

To You, our ACA friends, Thank you

COMPULSIVE GAMBLING “ACTION” INVENTORY©

This inventory is administered by the clinician with the gambler and in the presence of family members and significant others, who are asked to be silent until the interview with the gambler is completed. This session will help in understanding the gambler’s thoughts, feelings and behaviors during one day of active gambling while in the out-of-control phase of gambling.

Name Sex          Age             # Years Gambled              # Years out of control             

Type of gambling described during this interview Where Today’s date

Problems created by my gambling

This survey instrument was developed by Valerie C. Lorenz Ph.D., Forensic Center on Compulsive Gambling, Baltimore. Administration requires brief training. It is recommended that data be collected and presented to the field. The Inventory and author must be referenced in writings. © 1995, R2003, R2008