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Gambling:The silent addiction
Oct. 10, 2013Jennifer Clegg, MSW, LSW, NCGC-II/BACC, OCPS-II
Gambling Program SpecialistRecovery Resources
3950 Chester AveCleveland, OH 44114
www.facetheodds.org
What is Gambling?
Gambling is risking something of value on an event that is determined mostly by chance.
A person is gambling if:• he or she puts up something of value, such as
money or property• the outcome has an element of chance beyond
the person’s control• once the bet is made, it’s not reversible
Types of Gambling Activities
– Lottery, scratch, pull-tabs and raffle tickets– Bingo– Sports betting– Slot machines– Card and table games– Horse betting– Internet gambling– Stock market speculation– Betting on other games– Other?
Plays with $ that is needed or borrowed.
Expects to win; keeps playing to win back losses.
Is revolved around
gambling.
Frequent, or spends more time
gambling.
Sticks to limits of money to play with.
Hopes to win butexpects to lose.
Can take it or leave it.
Occasional gambler.
PROBLEM GAMBLINGSOCIAL GAMBLING
Problem or Not? Telling the Difference
Problem Gambling Definition
Gambling is a problem when it disrupts or damages your:
◦mental or physical health◦work, school or other activities◦relationships◦finances◦reputation
United States Estimates
• 1.5 % Pathological Gamblers
• 4% Problem Gamblers
Problem and pathological gambling rates in adolescents at least 2-3 times those of adults
Ohio
Cuyah
oga
Luca
s
Fran
klin
Hamilt
on0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
Low RiskModerate RiskHigh Risk
2012 Ohio Survey
9
Estimated Percent and Number of Persons for At-Risk and Problem Gambling in Ohio
Problem Gambling
The prevalence of at risk and problem gambling in Ohio is 2.8%, which equates to an estimated 246,561 individuals in the target population of 8,805,761.*
*(18 years and older)
No Problem LowRisk
Moderate Risk
Problem
Don’t Gamble
Gamble
43.3% 53.8% 2.2% 0.3% 0.3%
3,812,895 4,737,499 193,727 26,417 26,417
Of the 8.8 million Ohioans aged 18 and older, an estimated 3.8 million (43.3%) do not gamble. Of the Ohioans who do gamble, an estimated 4.7 million (53.8%) do not experience any risk factors.
Prevention activities may be beneficial if directed at the 220,144 (2.5%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as Gamblers Anonymous should be directed at the 0.3% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria.
Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 2,640 individuals may seek treatment or seek out self-help such as Gamblers Anonymous.
10
Map of Cuyahoga Cluster Area
11
Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Cuyahoga County Cluster
Problem Gambling
The prevalence of at risk and problem gambling is 11.6% which equates to an estimated 145,143 individuals in the target population of 1,251,231.*
*(18 years and older)
No Problem LowRisk
Moderate Risk
Problem
Don’t Gamble
Gamble
28.8% 59.6% 9.5% 2.0% 0.1%
360,355 745,734 118,867 25,025 1,251 Of the 1.25 million Ohioans aged 18 and older in the
Cuyahoga area, an estimated 360,355 (28.8%) do not gamble. Of the Ohioans in this cluster who do gamble, an estimated 745,734 (59.6%) do not experience any risk factors.
Prevention activities may be beneficial if directed at the 143,892 (11.5%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 0.1% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria.
Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 125 individuals may seek treatment.
12
Map of Lucas County Cluster Area
13
Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Lucas County Cluster
Problem Gambling
The prevalence of at risk and problem gambling is 14.8% which equates to an estimated 62,652 individuals in the target population of 423,316.*
*(18 years and older)
No Problem LowRisk
Moderate Risk
Problem
Don’t Gamble
Gamble
30.7% 54.5% 11.9% 2.7% 0.2%
129,958 230,707 50,375 11,430 847
Of the 423,316 Ohioans aged 18 and older in the Lucas County Cluster, an estimated 129,958 (30.7%) do not gamble. Of the Ohioans in the cluster who do gamble, an estimated 230,707 (54.5%) do not experience any risk factors.
Prevention activities may be beneficial if directed at the 61,805 (14.6%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 0.2% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria.
Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 84 individuals may seek treatment.
14
Map of Franklin County Cluster Area
15
Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Franklin County Cluster
Problem Gambling
The prevalence of at risk and problem gambling is 14.2% which equates to an estimated 153,815 individuals in the target population of 1,083,205.*
*(18 years and older)
No Problem LowRisk
Moderate Risk
Problem
Don’t Gamble
Gamble
37.6% 48.2% 9.2% 4.8% 0.2%
407,285 522,105 99,655 51,994 2,166
Of the 1,083,205 Ohioans aged 18 and older in the Franklin Cluster, an estimated 407,285 (37.6%) do not gamble. Of the Ohioans in this cluster who do gamble, an estimated 522,105 (48.2%) do not experience any risk factors.
Prevention activities may be beneficial if directed at the 151,649 (14.0%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 0.2% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria.
Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 216 individuals may seek treatment.
16
Map of Hamilton County Cluster Area
17
Estimated Percent and Number of Persons for At-Risk and Problem Gambling – Hamilton County Cluster
Problem Gambling
The prevalence of at risk and problem gambling is 12.7% which equates to an estimated 108,453 individuals in the target population of 853,962.*
*(18 years and older)
No Problem LowRisk
Moderate Risk
Problem
Don’t Gamble
Gamble
31.6% 55.7% 7.8% 3.5% 1.4%
269,852 475,657 66,609 29,889 11,955
Of the 853,962 Ohioans aged 18 and older in the Hamilton County Cluster, an estimated 269,852 (31.6%) do not gamble. Of the Ohioans in this cluster who do gamble, an estimated 475,657 (55.7%) do not experience any risk factors.
Prevention activities may be beneficial if directed at the 96,498 (11.3%) persons who are estimated to be at-risk for problem gambling, while treatment services and/or self-help programs such as gamblers anonymous should be directed at the 1.4% who are estimated to have a gambling problem that meets DSM-IV diagnostic criteria.
Approximately 10% of those who need treatment will seek treatment (Cunningham, 2005), suggesting that approximately 1,195 individuals may seek treatment.
Gambling and Incarceration 43.7 % of Pathological Gamblers have
committed crimes (Blaszynski, McConaghy, Francova, 1989)
Various reports indicate 255-50% of incarcerated offenders meet criteria for problem or pathological gambling (Zorland, Mooss, Perkins,
2008)
Gambling and Arrest Rates
Pathological gambler
Problem Gambler
Low Risk Gambler
No Gambling
Arrest rates 32% 32% 10% 4.5%
# of times arrested
3.3 1.6 2.1 1.7
Imprisoned 23% 13% 6%
National Gambling Impact Study, NORC 1999
Impact
• Each compulsive gambler costs society $13,000.00 each year.
• In Ohio: more than $2.2 billion each year.
• One estimate: $289 in social costs for every $46 economic benefit
• It is estimated that each problem gambler will directly impact the lives of a minimum of 7 other people – mostly family.
Gambling Consequences Debt
◦ $38,000 to $113,000
Illegal Activities◦ 60% estimated to commit illegal acts
Crimes Embezzlement Forgery Identity Theft Fraud Robbery Drug Dealing Assault
• Chemical Dependency• Tolerance, as defined by either
of the following:o a need for markedly
increased amounts of the substance to achieve intoxication or desired effect
o markedly diminished effect with continued use of the same amount of substance.
Comparison of CD and Gambling
Tolerance• Pathological Gambling• needs to gamble with
increasing amount of money in order to achieve the desired excitement.
• Chemical Dependency• withdrawal, as manifested by
either of the following:o the characteristic
withdrawal syndrome for the substance
o the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
Comparison of CD and Gambling
Withdrawal• Pathological Gambling• is restless or irritable when
attempting to cut down or stop gambling
• Chemical Dependencyo the substance is often taken in
larger amounts or over a longer period than was intended
o there is a persistent desire or unsuccessful efforts to cut down or control substance use.
Comparison of CD and Gambling Loss of control
• Pathological Gambling:• repeated unsuccessful effort to
control, cut back, or stop gambling.
Chemical DependencyA great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
Comparison of CD and Gambling
Preoccupation• Pathological Gambling• is preoccupied with gambling …
• Chemical Dependencyo important social, occupational,
or recreational activities are given up or reduced because of substance use.
o the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been causes or exacerbated by the substance…
• Pathological Gambling:o lies to family member,
therapist, or others to conceal …gambling
o has committed illegal act …to finance gambling.
o has jeopardized or lost a significant relationship, job or educational or a career opportunity because of gambling
Comparison of CD and Gambling
Consequences
Comparison of CD and Gambling
• Similarities
Preoccupation• Lack of control• Ambivalence (rather than denial or resistance)• Substance use• Depression• Escape• Family dysfunction• Intolerance• Chasing• Need immediate gratification• Shame• Co morbidity
Comparison of CD and Gambling
• Differences
Not easily detected
Fantasy/Dream Life• Not self limiting, can’t pass out or overdose• Job, family, functional• Suicidality• Hopelessness• Financial (extreme debt)• Family impact (finances)• Social perception of gambling• Few resources• Solitary
• A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:
• Preoccupation• Gamble more money in order for desired excitement• Unsuccessful at control, cut back, or stopping gambling• Restless or irritable when cut down or stop• Escaping problems / relieving a dysphoric mood• Chasing• Lies • Illegal acts to finance gambling• Risked or lost a significant relationship, job, or school• Bailouts to relieve a desperate financial situation
• B. The gambling behavior is not better accounted for by a Manic Episode.
Pathological Gambling DSM IV
Pathological Gambling DSM VProposed changes
New Name: ◦Disordered Gambling
New Classification: ◦Addiction and Related Disorders
Disordered Gambling the only behavioral addiction
Pathological Gambling DSM VProposed changes
Why change? ◦Reward center research
Similarities to Substance Use Disorders Cravings Highs Hereditary nature Similar treatment
12 step CBT MI
Pathological Gambling DSM VProposed changes
“Is preoccupied with gambling” most useful criteria with lowest levels of gambling severity
“Illegal acts” is most helpful only for highest levels of gambling severity
Result…consider dropping the Illegal Act criteria
Strong and Kahler, 2007
TardinessMissing work
StealingMood swings
Criminal activityTheft/RobberyEmbezzlement
Drug dealingShoplifting
Secrecy/withdrawalUnexplained debts/cashMissing moneyIncreased anxietySubstance use
FAMILY COMMUNITY Work
Signs that May Point to a Gambling Problem
♠ Loss of control over gambling behaviorsSpending more money than intendedPlaying for longer periods than intendedPlaying more often than intendedWanting to gamble when one knows
they should be doing other thingsNot being able to stop thinking
about gambling
♦ Being preoccupied with gamblingFrequently talking about gamblingOften thinking of the next
gambling venture
♥ Lying about one’s gambling
♣ Borrowing and stealing money from friends, family members and others in order to keep gambling.
The following can be found at: http://www.problemgambling.az.gov/screeningtools.htm
◦SOGS-R (South Oaks Gambling Screen-Revised)◦NODS (National Opinion Research Center DSM
Screen for Gambling Problems)◦NODs CLiP◦GA 20 Questions
The following can be found at: http://www.npgaw.org/media/pdfs/PDF3.pdf
◦ SOGS-RA (South Oaks Gambling Screen-Revised Adolescent)
Screening Tools
The following can be found at: http://www.oregon.gov/DHS/addiction/gambling/2010/bbgs.pdf?ga=t
◦BBGS – Bio-Social Gambling Screen
The following can be found at: http://www.problemgambling.ca/EN/ResourcesForProfessionals/Pages/IGS.aspx
◦ IGS- Inventory of Gambling Situations
Additional Screening Tools
Brain Activity to losses/gains
Gambling Activity
Identification of risk adverse..at the track and further
WIN◦ Ventral striatum becomes activated, flooded with
dopamine (sex, drugs, pleasure)◦ Once activated want more..and more and more
LOSS◦ The same area of the brain become less active◦ Risk aversion
For Pathological Gamblers in that gambling activity
The Ventral Striatum remains unreactive EVEN DURING WINNING STREAKS
Decreased response to the “high” Decreased activation in the ventrolateral
prefrontal cortex Keep gambling despite negative impact Keep gambling to increase to normal levels
of dopamine Seen in SUD
Clark et al 2009
Pathological Gambling addiction
The brain is hijacked….◦ When triggered with a gambling cue the area of the
brain responsible for impulse control is off
◦ Potenza et al 2003
Gambling Court It is a therapeutic, intervention and
rehabilitative approach — within the criminal justice system and under judicial supervision — for defendants who commit non-violent crimes because of gambling addiction.
Gambling Court Started by Judge Mark Farrell in New York State in
2001 350 people screened for gambling addiction 100 deemed appropriate for diversion 27 have graduated from treatment programs Only 3 have returned to the legal system, with non-
gambling offenses The cost of gambling court treatment is only one
sixth the amount of money it costs to keep someone in jail.
Gambling Court
http://gamblingcourt.org/videoFarrell.php
www.gamblingcourt.org
RULES OF RESPONSIBLE GAMBLING
TREAT THE MONEY YOU LOSE AS THE COST OF YOUR ENTERTAINMENT: Treat any winnings as a bonus.
PLAN AHEAD: SET A DOLLAR LIMIT AND STICK TO IT. Decide before you go not only what you can "afford" to lose, but how much you want to spend. Do not change your mind at the casino after losing.
SET A TIME LIMIT AND STICK TO IT: Decide how much of your time you want to allow for gambling - leave when you reach the time limit whether you are winning or losing.
BE PREPARED TO LOSE: The odds are that you will lose. Accept loss as part of the game.
MAKE IT A PRIVATE RULE NOT TO GAMBLE ON CREDIT: Do not borrow to gamble.
CREATE BALANCE IN YOUR LIFE: Gambling should not interfere with or substitute for friends, family, work or other worthwhile activities
AVOID "CHASING" LOST MONEY. After you've reached your designated dollar limit, DON'T continue to play in order to try to win back the money. Stop gambling and go see a show, or go home.
DON’T GAMBLE AS A WAY TO COPE WITH EMOTIONAL OR PHYSICAL PAIN. Instead, talk to a friend, a family member or a professional counselor.
BECOME EDUCATED ABOUT THE WARNING SIGNS OF COMPULSIVE GAMBLING
Abstinence is recommended when:
• you are experiencing significant financial problems;
• you continue to see gambling as a solution to financial problems;
• you gamble to escape and/or cope with negative situations and moods;
• your gambling is related to an impulse disorder;• you have been mandated to by the legal system;• you have already made unsuccessful attempts
to reduce your gambling; or• your relationships or employment may be at risk
if you continue to gamble.
Treatment Recovery Resources Gambling Service
◦ Assessment◦ Individual Counseling◦ Group Therapy◦ Family Therapy◦ Prevention Education Services
Treatment Recovery Resources Services
◦ Assessment◦ Substance abuse treatment◦ Case management◦ Mental health services◦ Education and prevention services◦ Adolescent treatment services
What can you do? For more information about our services at
Recovery Resources, please call, 216-431-4131.
Please visit our website at www.recovery-resources.org
For more information about the gambling services at Recovery Resources, visit our website at www.facetheodds.org
Ohio Hotline
1-800-589-9966
Toledo
Athens
Cleveland
Youngtown
Columbus
Cincinnati
Resources www.facetheodds.org – Recovery Resources Gambling website
www.recovery-resources.org – Recovery Resources website
www.gamblingcourt.org – Gambling Court in New York State
www.ncpgambling.org – National Council on Problem Gambling
www.pgnohio.org – Problem Gambling Network of Ohio
http://www.gamblersanonymous.org/mtgdirOH.html - GA meetings
www.npgaw.org – National Problem Gambling Awareness Week
www.odadas.state.oh.us – Ohio Department of Alcohol and Drug Addiction Services
AthensHealth Recovery Services244 West State St.Athens, Ohio 45701Toll Free: 866-614-9588Phone: 740-589-3680Fax: 740-594-3727
CincinnatiCentral Community Health BoardDrug Services Program3020 Vernon PlaceCincinnati, OH 45219513-559-2056
ClevelandRecovery Resources
Jennifer Clegg, MSW, LSW, NCGCI14805 Detroit Ave. Suite 200Lakewood, OH 44107216-923-4001 ext. 4215
ClevelandCleveland V.A. Hospital Wade ParkHeather A. Chapman, Ph.D., NCGC II10701 East Blvd., 3rd Floor, Room # 3A165Cleveland, OH 44106 (440) 526-3030 x 6962
ColumbusMARYHAVEN MAIN CAMPUS1791 Alum Creek DriveColumbus, Ohio 43207Phone (614) 445-8131
ToledoSubstance Abuse Services832 Adams StreetToledo, OH 43624419-243-7274
YoungstownMeridian ServicesLynn Burkey NCGCI527 North Meridian RoadYoungstown, OH 44509330-797-0070
Resources www.facetheodds.org – Recovery Resources Gambling
website
www.recovery-resources.org – Recovery Resources website
www.gamblingcourt.org – Gambling Court in New York State
www.ncpgambling.org – National Council on Problem Gambling
http://www.gamblersanonymous.org/ - GA meetings
www.npgaw.org – National Problem Gambling Awareness Week
www.odadas.state.oh.us – Ohio Department of Alcohol and Drug Addiction Services
www.org.ohio.gov – Ohio for Responsible Gambling
