1.GAMBLING SAPP 408 | University of OregonWinter 2013 | Julie Hynes

2. Outline: Our Time in Class History & trends Defining the issue Gambling & the brain Vulnerable populations: spotlight on youth Addiction & mental health connections Addressing the issue Wrapping up & assignments 3. Some of Your Wishes for thisClass (per pre-class survey) I want to know how online gambling is illegal butyet it is so available. My interest is learning how to deal withovercoming a gambling addiction. I am interested in knowing more about how thisproblem begins/when do people know they areactually addicted. 4. Learning Preferences(pre-class survey)If I had to choose how we spent most of our time in classon 1/24, my preference in order would be: (Order: "1" isMOST preferred, "5" is LEAST preferred) 5. Getting to Know EachOther 6. $ Opportunity 7. GamblingTo risk money or something of value on the outcome of an unpredictable event. 8. Anything Can Be a BetImage sources: ninersnation.com, docsports.com, bovada.lvOddsshark.com, wagerminds.com 9. Legal Gambling?in Oregon Nine tribal casinos opened 1994 - 2004Video poker began1992 Lottery approved19311984 1989Sports Action Lottery 10. Image sources: Oregon Lottery, Hynes 11. Image sources: Oregon Lottery, Hynes 12. Oregon Lottery Revenues 13. Electronic Gambling: BigHook Oregon Gambling Treatment Gamblers Preferences Electronic Gambling 87% Cards6%Other 5%Photo source: Daniel Berman.Source: Oregon Health Authority(2012; ibid) 14. Photo: Hynes 15. Photo: Hynes 16. Online Gamblinghttp://abcnews.go.com/GMA/video/fbi-cracks-internet-gambling-13389539 17. The Big 3 Screenshots,1/20/13 18. Online Gambling: Big Changes http://youtu.be/j0shB567K4MSource: ABC News 19. [game we played in class] 20. All walks of life, all over But Im telling you that if your picture of a compulsive gambler is a guy thats got a 5-day beard at 12 oclock on a Sunday night at the racetrack, that aint it. In going to Gamblers Anonymous for 10 years, there are doctors, there are lawyers, there are nurses, there are housewives, there are school teachers. This disease can affect anyone.Source: http://www.businessweek.com/ap/2012-10-02/ohio-gambling-survey-gives-pre-casino-picture 21. Definitions PATHOLOGICAL: Persistent and recurrent maladaptive gambling behavior...results in the PATHOLOGICAL GAMBLING LOSS OF CONTROL over gambling. (DSM-IV)also calledcompulsive gambling orgambling addiction 22. Gambling: A ContinuumNo Recreational At-Risk Problem PathologicalGambling Experimentation 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% 3Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & DataServices (2007). 5. Moore (2001). 23. Social/Recreational orProblem Gambler? Recreational Problem Gambler GamblerOccasionalFrequent, preoccupiedSticks w/ limits Plays w/needed $, borrowsHopes to win, expects toHopes & expects to WIN loseCan take it or leave it Primary source of fun 24. DSM-IV:Impulse Control Disorder 25. Signs: PathologicalGambling (DSM-IV)1. Preoccupation with6. Chases losses gambling7. Lies to others to conceal2. Increases amount of gambling money gambled 8. Has committed illegal3. Unsuccessfully tries to acts quit9. Has jeopardized4. Restless or irritable whenrelationships trying to cut down/stop 10. Relies on others to bail5. Gambles as an escapehim/her out *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). 26. DSM-V: DSM-V will define pathological gambling as abehavioral addiction,the first of its kind. 27. THOUGHTS, FEELINGS, ANTICIPATION, FANTASY(Gamblers Mind, Gambling Time/Gambling Money) REALITY(Self with Others,Real Time, Real MoneyACTION PLANNINGCYCLE (Removing obstaclesto gambling)CRASHGuilt, Shame, Anger, Denial,Justification, Restless, Irritable,GAMBLINGDepression, Panic or Numb,(Winning & Losing)Suicidal Thoughts Serotonin Adrenaline DopamineSource: http://www.oregon.gov/oha/amh/gambling/gear-workbook.pdf 28. Debt - $30,000 Crime 25%Source: Oregon Health Authority, 2012, Register-Guard, 5/13/11 29. OF PROBLEM GAMBLERS IN OREGON TREATMENT: >70% 48%are currentexperience tobacco users suicidal ideation 32% 10%actually attempthave currentsuicidealcoholHave current problemsdrug problems Source: Oregon Health Authority, 2012 30. Phases of Problem GamblingWinning LosingHitting Bottom Desperation Crime DivorceDesperation Depression/Suicide Getting help?Source: Custer, R. (1980). Custer Three Phase Model. 31. Causes? (Risk Factors) Trauma -- stemming Community norms/lawsfrom abuse or neglect Early initiation Mental health issues Friends favorable Substance use toward gambling Parental attitudes &behavior Competitive family 32. Group Exercises &Discussions 33. At what age is thebrain consideredfully developed? 18 21 25 16 34. 25PrefrontalCortex 35. Addiction is a DevelopmentalDisease- National institute on Drug AbusePrefrontalCortex 36. Neurobiology Still not well understood Multiple neurotransmittersystems believed involved: Seratonin Norepinephrine (aka noradrenalin) Opioid Dopamine Important to consider intreatmentSource: Grant, 2006. Neurobiology and Pharmacological Treatment of Pathological Gambling. 37. Potential NeurotransmitterRoles in PGNeurotransmitterRole in ImpulseControlSerotonin Serotonin -- risk taking Behavior Initiation/CessationNorepinephrine - NE levelsPGsArousal, Excitement OpioidsGambling - -endorphin Pleasure, UrgesDopaminePGs - dopamine responseReward, Reinforcement Dopamine: most studied neurotransmitter in problem gambling 38. Gambling & The Doped BrainDecisions that will likely cause us to lose money vs. win moneySource: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC 39. Superstition 40. Source: Bud Light Visitor (superstitious)https://www.youtube.com/watch?v=CZx5HO_duecGo Niners! 41. Interpretive bias 42. Source: Bud Light Labels Outhttps://www.youtube.com/watch?v=GPOQ8pzY0kY 43. Selective memory 44. Gamblersfallacy 45. How would you describe whatyou see below?[several slides followed duringthe lecture regarding patternseeking behavior] 46. What Comes Next?those are other ways ourminds trick us. We are wired to see patterns in things. 47. Gamblers fallacy Failure to see EACH roll of dice or EACH spin of wheel asindependent chance-related events That slot machine is DUE to hit. Illusion of control Relating winnings to skill, even in luck-based games Im smarter than that player. Superstition Selective memorySource: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1593-604. 48. In Perspective 49. Mental Health/Addictions Connections Depression/mood disorders Narcissistic personality disorder PTSD Impulsivity ADHD Substance abuse Alcohol abuseSources Ledgerwood & Petry (2006). Kausch et al. (2006). Biddle et al. (2005). Oregon Health Authority (2010). TheWAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001) 50. UO Survey 2010A majority of students (62%) thoughtproblems with gambling could bechanged through will power.At the same time, an even largermajority (87%) agreed that gambling isan addiction similar to a drugor alcohol addiction.Complete survey summary available at: http://preventionlane.org/gambling/collegesurvey.htm 51. Is it an Addiction1. Solidly established, problematic pattern of a pleasurable & reinforcing behavior2. Physiological/psychological components of behavior pattern that create dependence3. Interaction of these components in an individual which makes person resistant to changeDefinition of addiction from Diclemente (2003) Addiction And Change:How Addictions Develop And Addicted People Recover. 52. The Addiction Connection Similarities? Differences? Group activity (we skipped this in class; see next slide) 53. The Addiction Connection Similarities?Differences? Loss of control Defining use (gambling) Denial Behavior not attributable to Depression/mood swings chemical ingestion Progressive No biological test Tolerance Use as an escape More intense sense of shame Preoccupationand guilt (anecdotal) Similar highs Unpredictable outcome Self-help groups Fantasies of success /quitting is Family involvement giving up hope Use of rituals Easier to hide 54. Vulnerable Populations Older adults Substance abuse College students history Ethnic minorities Mental health Incarcerated persons history Military & veterans Youth Women 55. 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 thanpeers Higher risk of pathological gambling Suffer effects from lack of financialstability 56. The earlier people begingambling, the more likelythey are to experienceproblems from gambling.- National Academy of Sciences 57. Not Your UnclesGamblingResearchon: Youth gambling still under-studied & under the radar 58. Amygdala active Fight or flight, The adolescent brain isemotionespecially sensitive to the Decision-makingeffects of dopamine.altered More vulnerable to risk- taking & impulsive behaviorsSource: Ramoski, S., Nystrom, R. (2007). 59. Gambling & Oregon Teens Six in 10 Oregon (63 percent) havegambled 46 percent gambled in the past year 3 percent gamble weekly or more Six percent problem gamblers or at risk Preferred games in order:Free Internet gambling-type gamesCards (poker)Sports betsGames of personal skillSource: Volberg, et al (2008; bid). 60. Lane County 2012 Student Wellness Survey (SWS) 2012 Gambling, Substance Use and Mental Health among Oregon Youth 50% 40%6th8thPercentage 30%11th 20% 10% 0% Gambling AlcoholBinge Marijuana Cigarettes Depression PsychAlcoholdistress Source: http://oregon.pridesurveys.com/esds.php?year=2011 n=55,611 students (18,885 6th grade; 21,368 8th grade; 15,358 11th grade) 61. Used alcohol in the past month100%90%80%70%60% Percentage50% Did not gamble40%Gambled30%20%10% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm 62. Binge drank in the last 30 days 50% 45% 40% 35% 30%Percentage 25%Did not gamble 20%Gambled 15% 10% 5% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm 63. Smoked cigarettes in the pastmonth 50% 45% 40% 35% 30%Percentage 25%Did not gamble 20%Gambled 15% 10% 5% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm 64. Used marijuana in the past month 50% 45% 40% 35% 30%Percentage 25%Did not gamble 20%Gambled 15% 10% 5% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm 65. Skipped school one or more days in the past month50%45%40%35% Percentage30%25% Did not gamble20% Gambled15%10% 5% 0%Grade 6 Grade 8Grade 11Available at: www.preventionlane.org/sws.htm 66. Conclusion?Teens who gamble are smoked up, toked up,drunk emo delinquents. 67. Conclusion?Teens who gamble are smoked up, toked up,drunk emo delinquents. 68. Conclusion: Problem Gambling isONE COMPONENT ofProblem Behaviors sexualbehavior delinquency ProblemBehaviors depression gambling substanceuse 69. yet its not always communicatedat home or school. 2012 Oregon Student Wellness Survey, Lane County (Esd) and Oregon; available at http://oregon.pridesurveys.com/esds.php?year=2011 70. Identification & Treatment 71. Online: click hereSource: Written by Robert L. Custer, M.D; retrieved from Council on Compulsive Gambling of New Jersey, Inc.. 72. Intervention Helpline 541.741.7107: emergence Or 24/7: 1.877.MY.LIMIT Referred to providerfor assessment Family members come in; later bring gambler in 73. A Simple Screen: Lie-Bet Tool(Johnson et al., 1988)1.Have you ever felt the need to bet moreand more money?2.Have you ever had to lie to peopleimportant to you about how much yougambled? 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 74. 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) 75. DSM-IV Criteria Revisited1. Preoccupation with6. Chases losses gambling 7. Lies to others to2. Increases amount of conceal gambling money gambled 8. Has committed illegal3. Unsuccessfully tries to quit acts4. Restless or irritable 9. Has jeopardized when trying to cutrelationships down/stop 10. Relies on others to5. Gambles as an escapebail him/her outPathological Gambling = Five or more of above, AND: The gambling behavior is not better accounted for by a Manic Episode. 76. Treatment is Free.24 hrs: 1877-my-limitOnline: 1877mylimit.org 77. Treatment Options in Oregon Minimal intervention: GEAR (GamblingEducation and Reduction) Outpatient treatment (44) Crisis respite (2) Residential treatment (1) 78. Emergence GamblingTreatment Program Treatment free for gamblers and loved ones 275 problem gamblers and family members treated last year Gender-specific Multimodal treatment Individual sessions - Family therapy Group sessions- Recreationalcounseling Didactic lectures - Audiovisual educ. Suggest to explore 12-step program 79. Other Facts onGambling Treatment in Oregon Only about 2% of Oregonians who needtreatment enroll Those enrolling who lived within a 50 mileradius of a casino were significantly more likelyto report casino as their primary venue 30% enter treatment through the statewidehelpline 80. Treatment is Effectiveand Inexpensive $3,224: Cost per successful completer 86%: Report no, or far reduced, gambling Source: Moore, T. 2011 Gambling Programs Evaluation Update. 81. Disrupting the Action Cycle Barriers to Money Treatment Support Systems Accountability H.A.L.T.S.Slide credit: Janese Olalde, MEd, CGAC, CADC 82. FAMILY TREATMENT ISSUESAllow venting of rage and betrayalEducation of compulsive gambling as an illnessFamily GroupsRenew sense of hopeEmpowermentSeek support treatmentGAM-ANONDONT KEEP SECRETS!Slide credit: Janese Olalde, MEd, CGAC, CADC 83. Family Financial Issues Create own avenue to financial stability(employment or other) Protect financial assets Close joint accounts Use automatic/electronicdeposits for gamblers income NO BAILOUTS!Slide credit: Janese Olalde, MEd, CGAC, CADC 84. Couple Issues in TherapySequencing with individual workAssess possibility of domestic violenceImpact on partner and childrenRole of money in the relationshipDeal with hurt, anger, mistrustDealing with unfolding truths Slide credit: Janese Olalde, MEd, CGAC, CADC 85. Comparison of Action andEscape Pathological GamblersActionEscape Excitement, competition Relief, escape from stressSkilled forms of gambling Luck forms of gambling (sports/poker, etc)(lottery, slots, bingo) Early onset of gamblingLater onset of gamblingMore likely to presentMore likely to present narcissistic or antisocial traitsdepressive/dysthymic traitsSource: Center for Substance Abuse Treatment, 2005. 86. Promotion & Prevention 87. Creating conditions in families, schools, andcommunities that promote thewellbeing of people Emotional and behavioral health Physical health 88. Targeting Parental AttitudesParental attitudesOregon parent/youth focus groups revealed: All parents in the groups said their kidsdidnt gamble All kids in the groups said they did gamble Neither sees gambling as risky 89. Targeting Parental Attitudes Most parents believe: Youth gambling is harmless Youth who gamble are unlikely to haveproblems in school Youth gambling is not associated withalcohol or drug useand those beliefs are part of theproblem 90. Risk Factors Single-parent household Started gambling before Gambling on 8th grade (earlycards/sportsinitiation) Being male, older teenParents who gamble-- Lower household income youth twice as likely to be at-risk gamblers & Competitive four times as likely to Having lost more thanbe problem gamblers$50 in a single monthSource: Volberg, et al (2008; bid). 91. Prevention: Statewide & Local Efforts Partnership with Department ofEducation Curriculum integration in schools Youth video Oregon youth prevalence study Community Resource Guide* Middle School Poster Contest Partnering with addictionsprevention providers/groups Policy & coalition work Resource guide can be downloaded at: 92. Crashed cars Scared straight Boot camp One-time activities 93. [follow-up link: best practiceshttp://preventionlane.org/best-practices.h 94. FocusOur efforts havea focus on: Public awareness Policy 95. Problem GamblingAdvisory Committee Meets monthly inEugene Works on policy &awareness issues Comprised ofprofessionals &communitymembers 96. Various Methods 97. Results Prevention and awareness efforts inOregon have been able to avert anincrease in the prevalence while facing adramatic increase in the availability ofgambling opportunities. Local efforts have provided preventionand awareness information to anestimated 1.3 million Oregonians. 98. Key Challenges in Prevention Youthful subject Perception ofharmlessness Stigma/shame Industry 99. Under $100$1,000-$2,500$100-$1,000 More than $2,500 100. Problem gamblingtreatment is free inOregon for gamblersAND loved ones. 101. Summarizing this evening Defining gambling & problem gambling Trends Addictions connections The brain Addressing problem gambling 102. Some of Your Wishes for thisClass (per pre-class survey) I want to know how online gambling is illegal butyet it is so available. My interest is learning how to deal withovercoming a gambling addiction. I am interested in knowing more about how thisproblem begins/when do people know they areactually addicted. 103. Assignments: Blackboard 104. Contact info: Julie Hynes, MA, CPS Course questions:hynes@uoregon.edu Other contact info: Lane County Public Health Prevention Program 541.682.3928 | julie.hynes@co.lane.or.us preventionlane.org problemgamblingprevention.org 105. Additional ReferencesAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., textrevision). Washington, DC: Author.Cross, Del Carmen Lorenzo, & Fuentes (1999). The extent and nature of gambling among college studentathletes. 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.htmDiClemente, C. (2003). Addiction and change: How addictions develop and addicted people recover. New York:Guilford Press.ECONorthwest (2009). The contributions of Indian gaming to Oregons economy.http://www.econw.com/reports/2009_ECONorthwest_Contributions-Indian-Gaming-Oregon-Economy-2007.pdfEngwall, Hunter & Steinberg (2004). Gambling and other risk behaviors on university campuses. Journal ofAmerican College Health. 52 (6); 245-255.Freimuth, M. (2008). Addicted? Recognizing Destructive Behavior Before Its 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 UnitedStates. Journal of American College Health. 52 (2); 53-62.Marotta, J. & Hynes, J. (2003, August). Problem Gambling Prevention Resource Guide for PreventionProfessionals. Salem, OR. Oregon Department of Human Services.http://preventionlane.org/gambling/Docs/Problem-Gambling-Prevention-Guide-Marotta-Jeffrey-Hynes-Julie.pdfMoore , T.L. (2002.) The etiology of pathological gambling. Salem, OR: Department of Human Services.http://www.oregoncpg.com 106. Additional ReferencesMoore, TL. (2006). Oregon gambling prevalence replication study. Salem, OR: Department of Human Services. http://www.oregoncpg.comMoore (2001). Older adult gambling in Oregon. Salem, OR: Department of Human Services. http://www.oregoncpg.comNorthwest Survey & Data Services (2010). Lane County Health & Human Services college gambling survey. http://www.preventionlane.org/gambling/college.htmOregon 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-brainRockey, 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.pdfShaffer, 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