- [Voiceover] Truly, thank you for that. As you guys are thinking about what is going on in the DSM-5, let's pause before we jump into this slide and let's put up the next polling question, polling question number two, please. And let's see where you guys are at with DSM-IV-TR or DSM-5 in your agency, your private practice or wherever you're working right now Casinoslots New Zealand .
Give it a minute for everybody to jump into that polling question. Are you just using DSM-IV or are you just using DSM-5? Neither or some of you are using both. And then in a few seconds we'll broadcast the results, if we haven't already. Let's see those results. Okay, one person is still just using DSM-IV and I want Denise E. to kind of address that and eight people are using DSM-5 already, that's shown some progression, more people than I expected are using DSM-5. There are zero agencies that are using neither. That gives me hope that you're using good materials out there, because, of course, there's controversy around DSM, but at least it's a springboard and it's something that we generally have to use if we're trying to get insurance and other reimbursement. And some people, two people, are using both. Denise if you could spend a minute, Denise E., talking about your experience with Medicaid and billing and what's happening with your use of the DSM-IV and five. - [Voiceover] Actually, the results were actually interesting to me too, because we are using primarily the four because of Medicaid. They have told us that they are not going to be moving to actually DSM-5 at all, now the reason for that is currently, we use the DSM-IV plus ICD-9 because the language in the two is not the same, so we need to use both for diagnosis and billing. When we move to ICD-10, after the the first of the year, is my understanding, it keeps being moved back, the language in the ICD-10 encompasses the language from the DSM-5, so there's no point in using two different documents, so we're gonna be only using the one document when that kicks into place, but for the time being, to get reimbursed by Medicaid and many insurance companies, we're still... (silence) trained in those kinds of things, so my staff is slowly getting trained in the DSM-5 because we will be using it as part of our Medicaid reimbursement in the ICD-10 just not necessarily separate and then I also wanted you, Denise Q., to address the issues around if you're going to be sitting for your alcohol, your licensure or certification in front of the oral board. - [Voiceover] Absolutely. When you are preparing to take the oral, well, first of all, the written, you have to certainly do a lot of book learning to get ready for the written and I know right now that the written exams for the alcohol and drug counselor for the state of Nevada test are all coming off DSM-IV and ASAM, so let me talk a minute about ASAM. The ASAM Criteria, it used to be ASAM PPC-2R, where we would do patient placement and use the... - [Voiceover] Crosswalk. - [Voiceover] Crosswalk, I wanna call it boardwalk, I knew it was a walk of some kind, we'd use all that crosswalk stuff for placement of our alcoholics and drug addicts. There was nothing like that for gamblers and that was the genesis of creating the Gambling Patient Placement Criteria because we wanted something specific for gamblers, so those of us who created that started noticing that as the ASAM criteria was being written over the last couple of years, my colleague, Colin Hodgen, and I had the privilege of being one of the field reviewers, two of the field reviewers out west here, and we got to see comments being made about what was necessary and what they wanted to have in the ASAM Criteria, so we even got our names in the back of the book, it's pretty exciting.
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Are they're lying to themselves or others about their gambling or are the amounts of their bets increasing. That Lie-Bet Screen is a perfect segue of any conversation that you're having with one of your clients that you're assessing about money and financial stress and as soon as you catch a whiff of any financial problems, if you simply ask, "Hey, are you lying to yourself or anybody about your gambling," and you can assume if they're having financial problems that there may be a gambler hiding in the closet somewhere, if it's not them, it might be somebody else. And if they say yes to that one, "Oh, well have you noticed the amounts of your bets increasing." Boom, you've got the perfect segue to do more screening and more assessment on the gambling problem. So that's a little gift, you can use that any time. And then a few words about DSM-5.
I want you to get a good look at the cartoon, because I think it is a good humorous rendition of what's going on in our day. This is a snapshot of the DSM-5, the Diagnostic Statistic Manual of Mental Disorders and I want to advise you that if you are about to take a DSM-5 class from anyone, you've been looking online, you wanna take a cheap, quick and dirty, get something off the internet, DSM-5 class, which I think everyone should do in their push for time. Do not take a class that says it's about DSM-V because that person did not pay attention to the fact that the new DSM-5 is using Arabic numerals, not Roman numerals anymore, (laughs) so if you wanna be on top of things, it's DSM Arabic numeral five, not Roman numeral V. It's kinda cute that the idea behind the cartoon there is that anything that could go wrong in any of our lives could possibly be mentioned (laughs) in the DSM as a mental disorder. Thus we are having more and more discussions about process addiction and behavioral addiction and gambling made the cut in the DSM-5 with all the 15 years of planning and discussion about what should go in DSM-5, we, I consider it we because I take some ownership having some expertise in this area, we were very happy when we saw that gambling disorder is the first of the behavioral addictions listed in the DSM-5. We know that there are others that didn't quite make the cut because they didn't have enough research or enough of whatever it was that the committee decided they needed and, frankly, many of us were disappointed about that. I know Denise and I were talking yesterday about it's stunning to me that food addiction did not make the cut because there's so much research and clients behind it. - [Voiceover] This is Denise E. There's a lot of research, I was just reading an article very recently about process addictions and there are several that are still on the drawing board and one of the interesting things about changing to the Arabic numbering system is that my understanding is from Denise Q., is that in the future, rather than rewriting the entire manual, they're going to adapt different sections and so it'll be 5.1, 5.2, 5.3, so they won't be waiting several years before we come out again with another manual because they're behind the times almost before the ink is dry. - [Voiceover] Absolutely. - [Voiceover] And so I think that's going to be extremely valuable and in the future, it might even be helpful if they did it in, kind of a three-ring binder kind of format, rather than having it hardbound and that way you can add in whatever the revisions are. All of the articles that I've been reading recently have talked about how there's a real movement afoot to include food issues, sex addiction and a variety of things, there's people who have problems with overspending, underspending, the financial recovery issues, debt, over and under earners, you know, those kinds of things, so it will be really interesting to see how the field evolves over the next few years. It's been my experience that some of my clients who have had horribly negative experiences with gambling, if I should use the term gaming, they will stop me and say, "That is not what it is." (laughs) And we're gonna talk more in a few minutes about how gamers, if you are talking about gamers now in this year, 2019, you need to differentiate between what kind of game they're playing, are they playing an interactive video game, a multiplayer game, are they just two little boys playing on their XBox and they've got their headset on and they're talking to their three other friends down the block, you know, those are gamers, or are they actually people playing some kind of a game of chance where the risk is involved and money is involved or something of value is involved. So the reason I'm giving you my favorite definition of gambling from Gamblers Anonymous, it's because I trust that since 1957 when Gamblers Anonymous was founded, piggybacking off the 12 Steps of Alcoholics Anonymous, gamblers know what problem gambling is, so you can have a definition of gambling at this website, or you can have this definition of a gambling problem from the viewpoint of an addictive gambler and you'll see that the key components are any betting or wagering, for yourself or for others, because I know plenty of codependent or non-codependent concerned family who think they're doing a fun thing going across state lines to buy lottery tickets and that is gambling, that is going out and doing the act of gambling, whether for money or not, as Denise mentioned earlier, it can be for something of value, no matter what, no matter how slight or insignificant where the outcome is uncertain or depends on chance or skill and lovingly, I think, GA put quotation marks around the word skill, because there are some games I would have no idea how to play, you could not convince me that there is a way to learn how to play craps in five minutes. I've seen people talk about it endlessly and the science behind it and I think, uh, it's just throwing dice, I don't get where the skill is, but some people say that there's skill involved and also the outcome being uncertain, that risky part, Denise E. is gonna be talking about adolescents in a little while, and boy, high-risk behavior with adolescents is all over who they are and what they do, so it doesn't become an addiction until all of these elements combine and loss of control, as you well know from the diagnostic criteria, has to be going on.
I put the little Yellow Combo Book picture at the bottom of this slide. If any of you are working with gamblers, whether it's children, adults, relatives, friends and somebody has a gambling disorder, or gambling problem or used to have a gambling problem, I heartily recommend you spend 50 cents and order this online through the Gamblers Anonymous website or get one at the nearest GA meeting because this little Yellow Combo Book, which is literally only about three or four inches tall, 17 pages long, has everything that you need to know for a basic GA meeting and for any gambler who wants to not gamble today. The essential information is on page 17 and they will tell you in a meeting, if you don't wanna gamble today, do everything that's on page 17. That is treasure for somebody who's brand new in recovery and is mortified that they have to live in this town where they're surrounded by gambling things and for the family who need to understand what the essence of Gamblers Anonymous is about. So if you don't have one, please get one. The Lie-Bet Screen is a two question screen that anybody can do, if you would like to use this silence determining, with science to back it up, because you've got a 90% reliability that there's a gambling problem if they answer yes to either or both of these. |
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