Julie Hynes, MA, CPS “Thinking Outside the Box”

NCA 2012 Conference

Inside the World of

Problem Gambling

What’s hidden in

those cards?

We aren’t going to talk about HOW to treat gamblers

Our Evening “Out of the Box” –

what it isn’t

What it is: • Why problem gambling

deserves our attention

• Addiction & mental health connections

• ID & referral

• Fun (Family Feud!)

Our Evening

“Out of the Box”

$

Opportunity

Gambling

To risk money or something of value on

the outcome of an

unpredictable event.

Image sources: sportsbet.com, bovada.com Oddsshark.com, wagerminds.com

Anything Can Be a Bet…

Betting on Brangelina

Image source: telegraph.co.uk Odds: wagerminds.org

Image sources: Oregon Lottery, Hynes

Not Your

Uncle’s

Gambling

Available

It’s everywhere.

Gambling: A Continuum

No

Gambling Experimentation

Recreational Problem Pathological

Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data Services (2007). 5. Moore (2001).

Between 2-3% adults 18+ problem gamblers Teens (13-17 y.o.): 6% at risk or problem gamblers 2

College age (18-24): 5.6% 3

At-Risk

“Social/Recreational” or

Problem Gambler?

Recreational Gambler

Occasional

Sticks w/ limits

Hopes to win, expects to lose

Can take it or leave it

Problem Gambler

Frequent, preoccupied

Plays w/needed $, borrows

Hopes & expects to WIN

Primary source of “fun”

PATHOLOGICAL: Persistent and recurrent maladaptive gambling behavior...results in the LOSS OF CONTROL over gambling. (DSM-IV)

Definitions

“PATHOLOGICAL

GAMBLING” also called

“compulsive gambling” or

“gambling addiction”

Signs: Pathological

Gambling (DSM-IV-TR)

6. “Chases” losses

7. Lies to others to conceal gambling

8. Has committed illegal acts

9. Has jeopardized relationships

10. Relies on others to bail him/her out

1. Preoccupation with gambling

2. Increases amount of money gambled

3. Unsuccessfully tries to quit

4. Restless or irritable when trying to cut down/stop

5. Gambles as an escape

*”Pathological” gambling = At least five of above, and not accounted for by a Manic Episode. Pathological Gambling is defined in DSM-IV as an “Impulse Control Disorder”

Source: American Psychological Association (1994).

“Addiction”

1. Solidly established, problematic pattern of a

pleasurable & reinforcing behavior

2. Physiological/psychological components of

behavior pattern that create dependence 3. Interaction of these components in an individual

which makes person resistant to change

Definition of addiction from Diclemente, 2003

The “Addiction” Connection

Loss of control Denial Depression/mood swings Progressive Tolerance Use as an escape Preoccupation Similar “highs” Self-help groups Family involvement Use of rituals

Differences? Similarities? Defining “use” (gambling)

Behavior not attributable to chemical ingestion

No biological test

More intense sense of shame and guilt (anecdotal)

Unpredictable outcome

Fantasies of success /quitting is giving up hope

Easier to hide

Debt - $30,000 Crime – 25% Depression/suicide

48% seriously considered suicide 9% attempted suicide

Relationship jeopardized/lost – 35% Concurrent alcohol problems – 34% Concurrent drug problems – 15%

Source: Oregon Health Authority, 2011

Phases of Problem Gambling

Hitting “Bottom”

Desperation

Crime

Divorce

Depression/Suicide

Getting help?

Winning

Losing

Desperation

Source: Custer, R. (1980). “Custer Three Phase Model.”

Causes? (Risk Factors)

Trauma -- stemming from abuse or neglect

Mental health issues

Substance use

Parental attitudes & behavior

Competitive family

Community norms/laws

Early initiation

Friends favorable toward gambling

Vulnerable Populations

• Older adults

• College students

• Ethnic minorities

• Incarcerated persons

• Military & veterans

• Women

• Substance abuse history

• Mental health history

• Youth

In Perspective

Addiction is a “Developmental

Disease”- National institute on Drug Abuse

Prefrontal Cortex

Neurotransmitter

Serotonin

Norepinephrine

Opioids

Dopamine

Role in Impulse Control

Behavior Initiation/Cessation

Arousal, Excitement

Pleasure, Urges

Reward, Reinforcement

Dopamine: most studied neurotransmitter in problem gambling

Serotonin -- risk taking

Gambling - β-endorphin

PGs - NE levels

PGs - dopamine response

Potential Neurotransmitter

Roles in PG

Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC

Gambling & The “Doped” Brain

Decisions that will likely cause us to lose money vs. win money

1 in 175

1 in 175,000

1 in 175 million

1 in 175 billion

1 in 175 Million (174,233,510)

Odds of getting struck by lightning:

1 in 280,000

Let’s say there is 1 RED popcorn kernel in this bag of 10,000 pieces of popcorn

….you’d have a better chance of reaching in and

grabbing the one red kernel

of popcorn in this bag than you would of winning $100 on a PowerBall ticket

So…if your lucky numbers

have “almost” come up in the

last 5 drawings, are your

chances better, worse, or the

same?

How would you describe what

you see below?

Magical Thinking

Superstition

Personalization

Selective memory

Cognitive Dissonance

Mental Health/Addictions Connections Depression/mood disorders

Narcissistic personality disorder

PTSD

Impulsivity

ADHD

Substance abuse

Alcohol abuse

Sources Ledgerwood & Petry (2006). Kausch et al. (2006). Biddle et al. (2005). Oregon Health Authority (2010). The WAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001)

Comparison of “Action” and “Escape” Pathological Gamblers

Excitement, competition

Early onset of gambling

Relief, escape from stress

Later onset of gambling

“Skilled” forms of gambling (sports/poker, etc)

More likely to present narcissistic or antisocial traits

“Luck” forms of gambling (lottery, slots, bingo)

More likely to present depressive/dysthymic traits

Action Escape

Source: Center for Substance Abuse Treatment, 2005.

Effects of Problem Gambling on

Children Prone to abuse and/or neglect

Child endangerment may increase

Higher levels of tobacco,

alcohol, drug use, and overeating than peers

Higher risk of pathological gambling

Suffer effects from lack of financial stability

•Amygdala active

• Fight or flight, emotion

• Decision-making altered

•More vulnerable to risk-taking & impulsive behaviors

Source: Ramoski, S., Nystrom, R. (2007).

“The adolescent brain is especially sensitive to the

effects of dopamine.

2010 Oregon Student Wellness

Survey (Lane County)

34.5

44.3

33.7

8.5

22.6

41.0

1.4

9.1

21.8

2.4

11.9

27.2

2.1

6.9

14.1

0

5

10

15

20

25

30

35

40

45

50

6th 8th 11th

Perc

en

tag

e

Grade

Lane County Youth

Gambled Drank Alcohol Binge Drank Alcohol Smoked MJ Smoked Cigarettes

Data Source: Oregon Student Wellness Survey, 2010 Full report available at: http://preventionlane.org/sws.htm

Youth gambling and alcohol use

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Grade 6 Grade 8 Grade 11

Pe

rce

nta

ge

Used alcohol in the past month

Did not gamble Gambled

Youth gambling and binge drinking

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Grade 6 Grade 8 Grade 11

Pe

rce

nta

ge

Binge drank in past 30 days

Did not gamble Gambled

Youth gambling and smoking

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Grade 6 Grade 8 Grade 11

Pe

rce

nta

ge

Smoked cigarettes in the past month

Did not gamble Gambled

Youth gambling and marijuana

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Grade 6 Grade 8 Grade 11

Pe

rce

nta

ge

Used marijuana in the past month

Did not gamble Gambled

Youth gambling and skipping

school

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Grade 6 Grade 8 Grade 11

Pe

rce

nta

ge

Skipped school one or more days in the past month

Did not gamble Gambled

Youth gambling and suicide attempts

Percent of youth who attempted suicide in the past

year

7.2%5.0%

11.3%9.0%

0%

5%

10%

15%

20%

25%

30%

Grade 8 Grade 11

Perc

en

tag

e

Did not gamble

Gambled

Youth problem gambling and

suicide attempts

Percent of youth that attempted suicide in the past

year

10.1%8.0%

21.0%18.6%

0%

5%

10%

15%

20%

25%

30%

Grade 8 Grade 11

Perc

en

tag

e

Did not

bet/gamble

more than

wanted to

Bet/gambled

more than

wanted to

Conclusion:

Teens who gamble are

smoked up, toked up,

drunk emo delinquents.

Conclusion:

Teens who gamble are

smoked up, toked up,

drunk emo delinquents.

delinquency

sexual

behavior

smoking

drug

use

gambling

Problem Behaviors

Problem Gambling is

ONE COMPONENT of Problem

Behaviors

identification &

treatment

University of Oregon Survey

2010

A majority of students (62%) thought problems with gambling could be

changed through ‘will power.’ At the same time, an even larger majority (87%) agreed that gambling is an addiction similar to a drug or alcohol addiction.

Intervention

• Intake/Assessment

• Referral to provider for assessment

• Family members in

The “Lie-Bet” Screening Tool (Johnson et al., 1988)

1.Have you ever felt the need to bet more and more money?

2.Have you ever had to lie to people important to you about how much you gambled?

• Valid and reliable for ruling out pathological gambling behavior • Response to ONE or both indicates referral for longer assessment • useful in screening to determine whether a longer tool (e.g., SOGS, DSM-

IV) should be used in diagnostics

preventionlane.org/gambling/lie-bet.htm

Assessment Tools

• “Valid and Reliable”

– DSM-IV 10

– South Oaks Gambling Screen (SOGS)

– SOGS-RA (Revised for Adolescents)

• Frequently Used

– Gamblers Anonymous 20 Questions (GA-20)

DSM-IV-TR Criteria Revisited

1. Preoccupation with gambling

2. Increases amount of money gambled

3. Unsuccessfully tries to quit

4. Restless or irritable when trying to cut down/stop

5. Gambles as an escape

6. “Chases” losses

7. Lies to others to conceal gambling

8. Has committed illegal acts

9. Has jeopardized relationships

10. Relies on others to bail him/her out

Pathological Gambling =

Five or more of above, AND: The gambling behavior is not better accounted for by a Manic Episode.

Treatment

Nebraska DHHS Gamblers Assistance Program:

• http://dhhs.ne.gov/behavioral_health/Documents/GAP-FY12-13ProviderManual.pdf

Nebraska Council on Compulsive Gambling

• www.nebraskacouncil.com

• $3,224: Cost per

successful completer

• 86%: Report no,

or far reduced, gambling

Source: Moore, T. 2011 Gambling Programs Evaluation Update.

Treatment is Effective

and Inexpensive

Thank you! For more Info…

Julie Hynes, MA, CPS

Lane County Public Health Prevention Program

541.682.3928 | julie.hynes@co.lane.or.us

preventionlane.org

problemgamblingprevention.org

References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Cross, Del Carmen Lorenzo, & Fuentes (1999). The extent and nature of gambling among college student athletes. Ann Arbor, MI: University of Michigan Department of Athletics.

Department of Defense (2002). Survey of health related behaviors among military personnel Washington, DC: Author. Report information available http://www.tricare.mil/main/news/dodsurvey.htm

DiClemente, C. (2003). Addiction and change: How addictions develop and addicted people recover. New York: Guilford Press.

ECONorthwest (2009). The contributions of Indian gaming to Oregon’s economy. http://www.econw.com/reports/2009_ECONorthwest_Contributions-Indian-Gaming-Oregon-Economy-2007.pdf

Engwall, Hunter & Steinberg (2004). Gambling and other risk behaviors on university campuses. Journal of American College Health. 52 (6); 245-255. Freimuth, M. (2008). Addicted? Recognizing Destructive Behavior Before It's Too Late . Maryland: Rowman & Littlefield Publishers.

Kerber (2005). Problem and pathological gambling among college athletes. Annual of Clinical Psychiatry. 17 (4); 243-7.

LaBrie, R., Shaffer, H., LaPlante, D., and Wechslet, H. (2003). Correlates of college student gambling in United States. Journal of American College Health. 52 (2); 53-62.

Moore , T.L. (2002.) The etiology of pathological gambling. Salem, OR: Department of Human Services. http://www.oregoncpg.com

References Moore, TL. (2006). Oregon gambling prevalence replication study. Salem, OR: Department of Human Services. http://www.oregoncpg.com

Moore (2001). Older adult gambling in Oregon. Salem, OR: Department of Human Services. http://www.oregoncpg.com

Northwest Survey & Data Services (2007). Lane County Health & Human Services college gambling survey. http://www.preventionlane.org/gambling/college.htm

Oregon Health Authority, Problem Gambling Services (2011). Oregon problem gambling awareness community resource guide. Salem, OR: Author. Oregon Lottery (2009). Oregon State Lottery Behavior and Attitude Tracking Study. November 2008. InfoTek Research Group, Inc.

Oregon Lottery (2008). Overview through fiscal year 2009. Salem, OR: Author.

Ramoski, S., Nystrom, R. (2007). The changing adolescent brain. Northwest Public Health. http://www.nwpublichealth.org/archives/s2007/adolescent-brain

Rockey, D.L., Beason, K.R., & Gilbert, J.D. (2002). Gambling by college athletes: An association between problem gambling and athletes. http://www.camh.net/egambling/archive/pdf/EJGI-issue7/EJGI-issue7-research-rockey.pdf

Shaffer, H.J., Donato, Labrie, Kidman, & LaPlante. (2005). The epidemiology of college alcohol and gambling policies. Harm Reduction Journal. 2 (1).

Shaffer, H.J. & Hall, M.N. (2001). Updating and refining meta-analytic prevalence estimates of disordered gambling behavior in the United States and Canada. Canadian Journal of Public Health, 92(3), 168-172.

Volberg, R.A., Hedberg, E.C., & Moore, T.L. (2008). Adolescent Gambling in Oregon. Northhampton, MA: Gemini Research. http://gamblingaddiction.org