An Interview with Ned Presnall, Licensed Clinical Social Worker and Addiction Treatment Specialist.

Treating Sports Gambling Addiction: Finding the Balance

Ned Presnall knows the challenge of helping someone to stop doing what they shouldn’t be doing—and it’s certainly not an easy job to have. As the Executive Director and Therapist at Clayton Behavioral in Saint Louis, Missouri, Presnall counsels people who are battling the grips of substance and gambling addiction on a regular basis, trying to help them break the cycle and avoid relapsing. But while it’s a rewarding profession, Presnall says there’s a delicate balance to strike between having empathy and making sure your work doesn’t create more stress than it should.

Presnall began his education by earning his Bachelor’s degree in religious studies and classics from Brown University. He then went on to earn his Masters of Social Work (MSW) from Washington University and subsequently earned licensure to become an LCSW (licensed clinical social worker). One of his first jobs after earning his Master’s degree introduced him to the practice of addiction counseling coupled with medication assisted treatment, a topic he’s passionate about.

Now in his career, he speaks regularly about medication assisted treatment and other topics at conferences and events such as the Missouri Addiction Counselor’s Association, Addiction Professional Magazine Panel Series in St. Louis, and the National Council on Alcoholism & Drug Abuse – St. Louis Area Coalition. Another facet to Ned Presnall’s career, and his ongoing effort to help struggling addicts, is his contributions to industry publications. He has provided insightful information to psychiatric journals such as the Journal of the American Academy of Child & Adolescent Psychiatry and the St. Louis Alliance for Re-Entry.

Enjoy our full interview with Ned Presnall, LCSW as he discusses the importance of social workers and psychologists keeping their own feelings balanced while helping those whose lives are in crisis.

eLearners: What made you decide to pursue a career as a licensed clinical social worker?

It is fulfilling to accompany and assist people as they make changes in their lives to achieve improved health and well-being.

eLearners: What types of challenges do those with sports gambling addictions face. How do they differ from those with drug or alcohol addictions?

Like any other addiction, gambling causes a person to severely compromise his or her values and priorities. Persons with gambling addiction traverse a demoralizing cycle of delusional hope and profound regret, which causes the rest of their life to spin out of control. Problem gambling is different from substance addiction primarily because it is an addiction to a behavior instead of a substance, but the neurological underpinnings are similar. Substance and gambling addictions involve a loss of control that is mediated by the same reward/stress pathways in the brain.

eLearners: Is there a certain treatment method or philosophy that you use—and if so, why?

I use both motivational interviewing and cognitive behavioral therapy. Motivational interviewing helps the patient to develop a sense of discrepancy between their values and priorities and their addictive behaviors. This discrepancy provides the seed from which they can develop an internal motivation for change. Cognitive behavioral therapy gives patients the tools to analyze their motivations and prevent relapse.

Although I’m not a physician, it is also important for me to educate my patients on medications that can decrease cravings and make relapse prevention more effective and to help patients integrate these pharmacotherapies into an effective relapse prevention plan. Medications have even been shown to help prevent relapse in problem gambling.

eLearners: When treating sports betting or gambling addiction is in-patient therapy common?

In-patient treatment is available for all addictions. Deciding the proper level of care for a person with an addiction requires careful assessment. While it used to be standard for persons to leave their natural environment for 30 days of in-patient treatment, outpatient treatment has become accepted as a preferred mode of treatment unless the problem is so severe that it requires round-the-clock care and stabilization.

The growth and success in outpatient treatment can be attributed to the fact that addiction is a process that takes place in a patient’s natural environment. To prevent relapse, a patient needs to learn to navigate that environment successfully. An artificial environment can provide safety and stabilization but cannot provide the necessary practice in relapse prevention that occurs in the natural environment.

eLearners: Do medications ever play a role in treating sport betting or gambling addiction? If so, how can they be effective?

There are no FDA-approved medications for treatment of gambling addiction, but patients have found success with opioid antagonists like naltrexone, in combination with psycho-social treatment. Serotonin reuptake inhibitors and mood stabilizers have also been successful in some problem gambling patients.

eLearners: What are some of the most rewarding—and challenging—aspects of your work?

I feel that I have a privileged vantage point from which to witness the courage and goodness of human persons.

As a mental health professional, you have to have a certain level of empathy and contemplative detachment. Change is difficult and is never guaranteed. Empathy provides a basis for staying engaged, meeting clients where they are, and having patience as people chart their own way forward.

Contemplative detachment allows us to remain healthy ourselves as we encounter human suffering day after day—some of which does not remit with treatment.

eLearners: Where do you see the future of addictions counseling heading?

The future of behavioral health in general lies is integration with mainstream medical treatment. For that reason, addiction and mental health counselors must see themselves as part of an interdisciplinary, integrated behavioral health system. Addiction counselors need to understand the biology and pharmacological treatment of addictive disorders. Likewise, medical professionals need to have some understanding of psycho-social treatment modalities in order to effectively coordinate treatment.

eLearners: How has earning your B.A. in Religious Studies influenced your practice?

More than earning my B.A., being a Jesuit for five years made me sensitive to a patient’s spiritual and religious beliefs and how that impacts their perception of themselves, other people, and the world. Like all belief systems and behaviors, religious belief systems and behaviors can impact mental health in positive and negative ways. Helping a person with a spiritual or religious tradition grow and change in positive ways often requires them to do so while integrating their faith and spiritual practices.

eLearners: What are some of the challenges that you faced when pursuing your Master’s degree and how did you overcome them?

One of the biggest challenges for all new social workers is maintaining a healthy sense of detachment as we work in helping roles with people who are suffering. The first few years of social work training and practice require students to develop strategies that help to keep work and personal life in balance.