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Addictive Behaviors - Problem Gambling

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Slides for "Problem Gambling: Hidden Addiction" class on 11/17/10 - Julie Hynes. University of Oregon Substance Abuse Prevention Program course on Addictive Behaviors with George Baskerville.

Slides for "Problem Gambling: Hidden Addiction" class on 11/17/10 - Julie Hynes. University of Oregon Substance Abuse Prevention Program course on Addictive Behaviors with George Baskerville.

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  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Course Description: John Bradshaw defined compulsive/addictive behavior as "a pathological relationship to any mood-altering substance or experience that has life damaging consequences."  Think of an activity other than substance use that you or a friend either really enjoy or find yourselves doing quite a lot of.  Have you often done more of the activity or for a longer period than was intended?  Have you persistently tried to cut down or control this activity?  Have you given up important social, occupational, or recreational activities because of this activity? Sat, Sun, 9:00 AM - 2:20 PM
  • True or False Breast cancer is the leading cause of cancer deaths among women in the US. False – Since 1987 lung cancer has been the leading cause of cancer deaths among US women. Over 90% of all lung cancer deaths are smoking related. The amount of nicotine in cigarettes has been steadily increasing since 1998. True – data from 1998-2004 and has found that the average nicotine yield of cigarettes increased 10%. Target audiences of the cigarette brands with the highest nicotine yield (Newport, Camel, and Doral) and the greatest percent increase (Doral and Kool) are some of the most vulnerable populations (minorities and youth). “ Additive free” and “natural” cigarettes (like American Spirits) are safer than other brands. False – Recent studies have found that additive-free cigarette delivered the nicotine, carbon monoxide and other toxic components of tobacco smoke in equal or greater amounts than conventional cigarettes. Smoking a hookah is less harmful than cigarettes because the smoke passes through water, which filters out the chemicals and other bad stuff. False – Passing through water in a hookah cools the smoke but does not filter out any chemicals or carcinogens. It actually forces the smoker to inhale twice as deeply causing the harmful smoke and cancer-causing agents to penetrate deeper into the lungs. New research shows that smoking increases weight gain. True - A recent study has found a few cigarettes a day may result in the body storing too much fat, not less.
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention 9,400 video poker machines in about 1880 bars & taverns — excluding casinos
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention Payments Mobile phone transfers Long distance phone time Third party Pre-paid debit cards eChecks Advertising: .net & .com
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • “ Deal or No Deal” game show theme used for educational purposes only. For information about this presentation and its use, contact Julie Hynes, Lane County Health & Human Services | 541.682.3928 | julie.hynes@co.lane.or.us At the end of the session, participant will be able to: Understand the prevalence of problem gambling among Oregon youth Identify relationships between gambling and other risky behaviors State the effects of problem gambling on youth, family members and the community Identify signs of a problem gambler Understand how and where to refer someone for help or assessment Identify at least 3 resources which can be used in problem gambling prevention Deal or No Deal? Play here! First Deal or No Deal question: What activity has correlations with drinking, drugs, sexual activity, and violent behavior, yet little or no attention is paid to it in health courses? Would you believe it’s youth gambling? Data from Oregon Healthy Teens surveys show that gambling and other risky behaviors often go hand-in-hand, yet many parents and educators unsuspectingly promote poker and other gambling-related games as harmless recreational activities. This session will provide useful information on an increasingly popular activity that is far from risk free and will address what can be done to minimize harm from gambling. We will have a fun, interactive multimedia game based upon the “Deal or No Deal” game show. Easy rules! Workshop participants will receive free DVDs and facilitator guides of Oregon’s new award-winning youth problem gambling prevention video.
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention Pathological gambling is characterized by a number of phenomenon, including: A preoccupation with gambling “ Magical” thinking - control the uncontrollable Total loss of control Chasing losses Lying and cheating Illegal acts Family bailouts Family disruption Basically, there is a continuation of the behavior despite the adverse consequences Gambling is no longer a form of recreation - it evolves - into the center of the individual’s life. Flip the coin
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling 1.1 million youth 12-17 exhibit pathological gambling behavior (National Gambling Impact Study Commission, 1999) 5 million youth have serious gambling related problems (Jacobs, 2000) A problem not limited to the US & Canada but England (Fisher, Griffiths), Australia (Moore & Oshutuka), New Zealand (PGFNZ) & Spain (Becona)
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention DiClemente, 2003: Addiction & Change: Self-regulated engagement: Balanced view of pros and cons and acknowledgement of the potential for negative consequences Action stage abuse & dependence: decisions focus on the positive end of the behavior; support repeated engagement Normalize & minimize problems associated with it Relationships, beliefs, attitudes, social systems are modified to support repeated engagement Quantity and frequency Own definition or pattern of what they consider “out of control” (gambling only on weekends, certain types of gambling, etc.)
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling http://braininstitute.vanderbilt.edu/Vanderbilt_March07_PotenzaLecture.ppt
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Other impulse control disorders: Kleptomania Compulsive sexual behavior Compulsive buying Pyromania Compulsive Internet use Trichotillomania
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Those entering treatment in Oregon had an estimated combined gambling-related debt of more than $44 million. Behavioral, psychological, physical A correlation between gambling and all forms of substance abuse exists. Gamblers are more likely to… Lose their jobs, be demoted Fall deeply into debt and file for bankruptcy Lose their homes and personal property Accumulate legal fees due to divorce, criminal activities Run up medical, mental health bills Well-demonstrated relationship of problem gambling with other risky behaviors Excessive alcohol use & binge drinking Regular tobacco use Illicit drug use Overeating/binge eating Source: Engwall & Steinberg, 2003; Ladouceur, Dube, &^ Bujold, 1994; Lesieur, et al., 1991
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling 15 months – 4x as fast as horse/dog betting
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Those entering treatment in Oregon had an estimated combined gambling-related debt of more than $44 million. Behavioral, psychological, physical A correlation between gambling and all forms of substance abuse exists. Gamblers are more likely to… Lose their jobs, be demoted Fall deeply into debt and file for bankruptcy Lose their homes and personal property Accumulate legal fees due to divorce, criminal activities Run up medical, mental health bills Well-demonstrated relationship of problem gambling with other risky behaviors Excessive alcohol use & binge drinking Regular tobacco use Illicit drug use Overeating/binge eating Source: Engwall & Steinberg, 2003; Ladouceur, Dube, &^ Bujold, 1994; Lesieur, et al., 1991
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling In a study of 111 veterans entering a problem gambling treatment program, 64 percent reported a history of emotional trauma; 30.5 percent, physical trauma; and 24.3 percent, sexual trauma. Most trauma had occurred in childhood (Kausch et al., 2006). www.responsiblegambling.org/en/research/PTSD_PG_proposal.pdf
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Chance gives the illusion of Control Failure to see the roll of the dice or the spin of the wheel as independent events Rely on past events to predict future of random events Thoughts of… If I do this, then this will happen This has already happened-- so this must now happen That can’t happen again Interpretive bias Relating my winnings to my skill. and ability makes me continue gambling ’ Cognitive approaches to gambling: http://www.cpa-apc.org/Publications/Archives/CJP/2003/february/tavares2.asp http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10468110&dopt=Abstract Toneatto 1999 These include the magnification of gambling skills, minimization of other gambler's skills, superstitious beliefs (including talismanic, behavioral, and cognitive superstitions), interpretive biases (including internal attributions, external attributions, gambler's fallacy, chasing, anthropomorphism, reframed losses, hindsight bias), temporal telescoping, selective memory, predictive skill, illusion of control over luck (including luck as an uncontrollable variable, luck as a controllable variable, luck as a trait variable, luck as a contagion), and illusory correlation. In addition, gambling-relevant beliefs about the self are also discussed, including entitlement, omnipotence, cognitive reasoning, and magical thinking. _____________ Social psychology perspective why gamblers are persistent “why they keep gambling against all odds” Illusion of control -- unrealistic confidence that we as humans can influence random events -- Study showed that people believed their lottery ticket was worth more of they personally selected the numbers rather than randomly distributed. Personal Choice- People believed they have a greater chance of winning a totally random game when they are given a chance to practice with the apparatus. Early wins- People who correctly predict heads or tails early in a sequence of coin toss in believe more strongly in their control than those who do not. Familiarity - People who are faniliar with a situation believe more strongly in their sense of control than people who are less familiar with it, even though chance determines the outcome. Types of Competitor People wager more against a seemingly incompetent bettor than a seemingly competent on even though once again the outcome is totally determined by chance. Practice- People believe they have a greater chance of winning a totally random game when they are given a chance to practice with the apparatus. Our tendency to interpret outcome in a self-serving way leads to our not using the outcome data effectively. We view success as related to our ability but failure as external. Once again this contributes to excessive confidence in our ability to succeed at a gambling. The way our minds work to organized cause and effect relationships leads us to believe random events are actually related. Bolstered by this belief we again assume an unwarranted confidence in our ability to predict and control future outcomes. Ex: Coin toss: Imagine a fair coin toss that has turned up tend heads in a row, many people predict that the chance of a tail coming up next is significantly higher than 50% even though probability states each outcome is totally dependent on the previous one.
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Loss of control - Repeated attempts to stop/cut back fail Denial - Not always a conscious act Progressive - between first-time use and addiction Chasing - throwing good money after bad Blackouts - not too common, but called “going on tilt” Escape - think valium Use of rituals - ever seen a serious bingo player? Similar highs - speaking physiologically Hidden - quite easy to hide from friends and family Overdose - can’t do it in the conventional sense Financial - Average debt called into the OR hotline is 20 - 40 thousand dollars Work - can function at work, usually can gamble in short bursts Tests - no UA for gambling Resources - more than 13,000 in U.S. providing substance abuse tx… Perception - where alcoholism was about 40 years ago. Just stop! Gambling questions added to a student survey in of Connecticut St. Univ. students in 2000 (n=1,348) Problem & pathological gamblers compared with social gamblers had significantly: Greater tobacco, alcohol, and marijuana use Greater binge drinking Greater number of negative outcomes from drug and alcohol use Greater binge eating and efforts at weight control
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Source: Grant, J. (2006, October.) Neurobiology and pharmacological treatment of pathological gambling. Presentation at Oregon Problem Gambling Services training, Bend, OR. Dopamine release associated with rewards and reinforcing Dopamine release - maximal when reward is most uncertain, suggesting it plays a central role in guiding behavior during risk-taking situations. Norephinephrine (NE) - an important component in the mediation of arousal, attention and sensation-seeking in PG PG had higher higher urine levels of NE. Opioid system: The endogenous opioid system influences the experiencing of pleasure. Gambling or related behaviors have been associated with elevated blood levels of the endogenous opioid β-endorphin.
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling http://braininstitute.vanderbilt.edu/Vanderbilt_March07_PotenzaLecture.ppt
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling http://www.youtube.com/watch?v=7A4Qxx7j63Y Recent studies have found that when we anticipate financial gains, an area of our brain known as the ventral striatum becomes activated and flooded with dopamine Release of dopamine also occurs during naturally rewarding activities such as eating, sex, physical activity -- & is a key factor behind our desire to repeat these activities To maintain even a normal level of dopamine in their brains, they must gamble with increasing frequency – and often for greater and greater stakes The impulse control in their brain is not functioning properly; drug addicts show a similar brain pattern – and a similar need to keep feeding their addiction studies have found that when we anticipate financial gains - whether at the gaming tables or on the stock market - an area of our brain known as the ventral striatum becomes activated and flooded with dopamine, a brain chemical linked to pleasurable sensations. The release of this chemical also occurs during physically rewarding activities such as eating, sex and taking drugs, and is a key factor behind our desire to repeat these activities. When we start to consider the possibility of losing money, however, the same brain areas become less active. In fact, most people's brains show more negative sensitivity to losses than positive sensitivity to gains - neural evidence of our tendency toward risk aversion. Once considered a character defect, gambling is now known to be a highly addictive disorder with neurological causes. Thanks to new advances in brain imaging, scientists are beginning to identify the neural mechanisms that go awry in the brains of pathological and problem gamblers. What they‟re learning from such research is also shedding light on how these same mechanisms determine individual risk tolerance – and influence the financial choices we all make throughout our lives. You hold your breath as the wheel spins on the roulette table. You briefly close your eyes as the croupier deals you another card at the blackjack table. You stand frozen in place as the horse you bet on lunges toward the finish line. At such moments – when you‟re anticipating the possibility of a financial reward – certain areas of your brain jump into action. The particular pattern of that activity, neuroscientists are now discovering, helps identify how risk-averse you are – not only when you‟re at the gambling table or the racetrack – but when you ponder any decision that involves some financial risk. Should you take a new job? Should you invest in a new business? Should you put your savings in potentially volatile stocks or in the “sure thing” of a bank certificate of deposit? Those same neural patterns may also reveal whether you‟re at risk of becoming a pathological gambler, someone so addicted to gambling that you continue the activity even while mounting losses ruin your personal finances and relationships. Recent studies have found that when we anticipate financial gains – whether at the gaming tables or on the stock market – an area of our brain known as the ventral striatum becomes activated and flooded with dopamine, a brain chemical linked to pleasurable sensations. The release of this chemical also occurs during physically rewarding activities such as eating, sex and taking drugs, and is a key factor behind our desire to repeat these activities. When we start to consider the possibility of losing money, however, the same brain areas become less active. In fact, most people‟s brains show more negative sensitivity to losses than positive sensitivity to gains – neural evidence of our tendency toward risk aversion. In one study, researchers could predict how tolerant individuals were to risk by analyzing how their brains responded to potential gains versus potential losses. Those whose brains were less turned off by the possibility of increasing their losses tended to be more eager gamblers. In pathological gamblers, neural activity in the ventral striatum remains remarkably unreactive – even during winning streaks. Their brains also show decreased activation in the ventrolateral prefrontal cortex – the brain‟s “superego” – which, when functioning normally, keeps people from acting impulsively. This finding may explain why pathological gamblers keep betting despite the havoc it inflicts on their lives. To maintain even a normal level of dopamine in their brains, they must gamble with increasing frequency – and often for greater and greater stakes. And the impulse control in their brain is not functioning properly. Drug addicts show a similar brain pattern – and a similar need to keep feeding their addiction. Recently, pathological gambling has been found to be a rare side effect of specific types of dopamine agonists, drugs used to treat the tremors and balance problems associated with Parkinson‟s disease. The dopamine boost from these drugs appears to overload receptors in the ventral striatum, causing an irresistible urge to gamble. The effect does not occur in everybody who takes dopamine agonists and it dissipates once the medication is discontinued. Source: http://www.sfn. Good introductory video on dopamine & dopamine receptors: http://www.youtube.com/watch?v=7A4Qxx7j63Y
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Previously, it was thought that most brain development was complete by adolescence and that teenagers‟ brains were as fully matured as adult brains. As the result of increasingly sophisticated research and imaging abilities, we now know this is not the case. Just as teens‟ bodies are maturing and their social skills are expanding, their cognitive centers are also in flux . During adolescence, the brain adopts a ―use-it-or-lose-it‖ pruning system , resulting in a decreasing number of connections among brain cells even as the speed of these connections increases. Major changes are also underway in the prefrontal cortex (PFC), known as the executive planner of the brain. The PFC is responsible for weighing risks and benefits, strategic thinking, and impulse control. Throughout adolescence, the PFC is refining its wiring to become more sophisticated. Studies demonstrate that the PFC is among the last parts of the brain to fully develop, in many cases not maturing until well into the third decade of life. Unused branches are sloughed off, and other pathways are refined. As this construction phase progresses, synapses that normally go through the PFC in an adult brain are instead re-directed to the amygdala, known as the emotional center of the brain. When this happens, the response is rooted in emotion—fight, flight, freeze, freak out—rather than rationality . The amygdala can also misinterpret others‟ facial emotions, perceiving fear or nervousness as anger or hostility. All these processes can alter the ability of adolescents to harness their decision-making abilities, making them more vulnerable to risk-taking and impulsive behaviors . As a parent, when you sometimes feel your son or daughter is over-reacting or misinterpreting, you have likely met their developing brain in action. The adolescent brain is especially sensitive to the effects of dopamine , a chemical neurotransmitter that is activated by substance use, exposure to high-intensity media, and gambling , as well as food and sex. It is still not known how much of brain development is influenced by environment vs. genetics, but some evidence suggests that constructive learning experiences can positively shape teen cognitive development. As research results have emerged, some public health professionals have voiced concern that the results will be used to squelch teen independence or rights in areas such as reproductive health and health care decisions. Public health policy and science provide us with a few key responses to that concern. First, brain development, as an isolated issue, should be just one of several factors considered when designing good programs and policies. Second, it is important to recognize that successful brain development relies on exercising this organ. From a use-it-or-lose-it perspective of refining maturing brain connections, it would be most productive for caring adults to provide meaningful opportunities for adolescents to exercise brain functions that require analytical, decision-making, and valuing skills, to help teens demonstrate their real and valuable role in making good decisions and advocating for their health. Source: http://www.nwpublichealth.org/archives/s2007/adolescent-brain 7
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention Gambling is everywhere This is the first generation to grow up with gambling as the norm and seen as harmless fun
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention 1.1 million youth 12-17 exhibit pathological gambling behavior (National Gambling Impact Study Commission, 1999) 5 million youth have serious gambling related problems (Jacobs, 2000) A problem not limited to the US & Canada but England (Fisher, Griffiths), Australia (Moore & Oshutuka), New Zealand (PGFNZ) & Spain (Becona) Problem is rising Youth are gambling more First generation of youth exposed to ready access & ways to gamble Rapid movement from social to pathological gambler Long-term costs unknown
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling University of Oregon | Problem Gambling: Hidden Addiction | 3.4.08 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling generic
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention Paid through Lottery funds Gambling Evaluation and Reduction Program (GEAR) Corrections Program 27 outpatient treatment centers (Emergence Program in Lane County) 3 crisis-respite programs 1 residential treatment program
  • Behavioral, psychological, physical A correlation between gambling and all forms of substance abuse exists. Gamblers are more likely to… Lose their jobs, be demoted Fall deeply into debt and file for bankruptcy Lose their homes and personal property Accumulate legal fees due to divorce, criminal activities Run up medical, mental health bills Well-demonstrated relationship of problem gambling with other risky behaviors Excessive alcohol use & binge drinking Regular tobacco use Illicit drug use Overeating/binge eating Source: Engwall & Steinberg, 2003; Ladouceur, Dube, &^ Bujold, 1994; Lesieur, et al., 1991
  • Problem Gambling: Hidden Addiction | UO Addictive Behaviors | 2.17.09 J. Hynes | Lane County H&HS | lanecounty.org/prevention/gambling Youth & Gambling: A Prevention Perspective | Safe & Healthy Schools Lane County H&HS Prevention Program | lanecounty.org/prevention

Addictive Behaviors - Problem Gambling Addictive Behaviors - Problem Gambling Presentation Transcript

  • Addictive Behaviors | 11.17.10 Julie Hynes , MA, CPS Lane County Health & Human Services hidden addiction :
  • Go Ducks! Photo source: http://www.thetribonline.com
  • Overview of This Afternoon’s Class
    • Gambling: Overview & trends
    • Defining “problem gambling”
    • Signs & addiction connections
    • Addressing the issue
    • Discussions
    Note: these online handouts have additional info for your reference | www.preventionlane.org/george.htm
    • Oregonians voted for the Lottery
    • Most people can gamble without harm
    • Some people cannot gamble without harm
    • Those who cannot gamble without harm should seek help…
    • So… safety is our primary concern.
  • Overview & Trends
    • Oregon’s #1 tourist attraction.
    • Until…
  •  
  • Legal Gambling in Oregon ? 1931 1989 Sports Action Lottery Video poker began 1992 Nine tribal casinos opened 1994 - 2004 Lottery approved 1984 2005 Video slots introduced
  • Oregon’s spending on gambling
    • Oregon Lottery 2009: $1.24 billion (Oregon Lottery, 2009)
    • Oregonians spent $1.6 billion on all forms of gambling in 2007 (EcoNW, 2007)
    • Lane County citizens spent an average of $330 per capita on lottery games in 2009 (Oregon DHS, 2010)
      • About $7 out of every $10 was spent on video lottery games (video poker & slots)
    • 18:
    • Traditional Lottery games
    • Charitable gaming
    • Pari-mutuel betting (e.g., race track)
    • 21:
    • Video Lottery
    • Casinos
    • Oregon: 9 tribal casinos
    • Each tribe has one casino
    • Different rules in Oregon
    • Tobacco: OK
    • Alcohol: OK
      • (2 casinos as of 2/10)
  •  
  • Photo source: Daniel Berman.
  • Photo: Hynes, 2/09
    • Video poker and other computerized gambling develop gambling disorders “faster”
    • More problem gamblers with a preference for video lottery than any other form of gambling
    • Provide a mechanism for escape, relieve boredom, promote fantasy, stimulate neurological systems
    • Deceptively expensive to play
      • You can bet $4.50 every five seconds on a five cent machine, $54 for each minute of play
  • Online Gambling
    • Fact (and Myth): Online gambling now illegal in U.S.
      • Technically: true.
      • Practically?
  • Groups: In-class discussion #1
    • Do a search for "online poker.“
    • Go to one of the sites that offers online poker. Is it a ".net" or ".com"? If it's a ".net," change the end of the URL to a ".com," and vice versa if it's a ".com.“
    • What changes between the URLs? What are the differences in content? Be prepared to discuss.
  •  
  •  
  • ? ? ?
  •  
    • 1 in 146
    • 1 in 146,000
    • 1 in 146 million
    • 1 in 146 billion
    • 1 in 146 Million (146,107,962)
    • 
    • 
    • Sports bets
    • Lottery tickets
    • Video & online
    • Bingo & raffles
    • Video lottery
    • & online gambling
    • 1%
    • 40%
    • 0.2%
    • 3%
    Research shows about what percentage of adults have a gambling problem?
    • About 3%
    • (2.7%) of Oregon adults have a gambling problem.
  • Problem Gambling
  • Teasing it out: Gambling in the context of “addiction”
    • DiClemente (2003) defines addiction as:
    • Solidly established, problematic pattern of a pleasurable & reinforcing behavior
    • Physiological/psychological components of behavior pattern that create dependence
    • Interaction of these components in an individual which makes person resistant to change
  • Definitions “ PATHOLOGICAL GAMBLING” also called “ compulsive gambling” or “gambling addiction” PATHOLOGICAL: Persistent and recurrent maladaptive gambling behavior...results in the LOSS OF CONTROL over gambling. (DSM-IV) PROBLEM GAMBLING: Gambling behavior which causes disruptions in any major area of life: psychological, physical, social, or vocational.
    • Adults: 2.7% 1
    • Teens (13-17 y.o.): 6% at risk or problem gamblers 2
    • College: 5.6% (nat’l figure) 3 | 3% (UO) 4
    • Older adults: 1.2% 5
    Sources: 1. Moore (2006; ibid). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data Services (2007). 5. Moore (2001).
  • Gambling: A Continuum No Gambling E xperimentation Social Problem Pathological 1.7% Source: Moore, TL. (2006). At-Risk 1.0% ~74,000 Oregon adults “problem gamblers” (2.7%)
  •  
  • Signs: Pathological Gambling
    • “ Chases” losses
    • Lies to others to conceal gambling
    • Has committed illegal acts
    • Has jeopardized relationships
    • Relies on others to bail him/her out
    • Preoccupation with gambling
    • Increases amount of money gambled
    • Unsuccessfully tries to quit
    • Restless or irritable when trying to cut down/stop
    • 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).
    • Debt - $32,000
    • Crime – 38%
    • Depression/suicide
      • 48% seriously considered suicide
      • 9% attempted suicide
    • Relationship jeopardized/lost – 35%
    • Concurrent alcohol problems – 34%
    • Concurrent drug problems – 15%
    Source: Oregon DHS, 2010
  • Electronic Gambling
    • Most Oregon problem gambling treatment clients say electronic gambling is their preferred method (video poker/slots, line games)
    Source: Oregon DHS (2010; ibid)
  • Groups: In-class discussion #2
    • What do you think are risk factors for problem gambling?
    • (Example: parent who has a gambling problem)
    • 5 minutes
    • Family history (includes sibling) gambling
    • Early initiation of gambling
    • Peer attitudes & involvement
    • Community laws & norms favorable toward gambling
    • History substance abuse
    • History mental health issues
    • Easy access to gambling
    • Competitive personality
    • Impulsive/risk-taking personality
    • Early “big win”
    Common Risk Factors Source: Marotta & Hynes, 2003
  • Groups Especially at Risk
    • Youth
    • Young adults
    • Athletes
    • Age 65+
    • Ethnic groups
    • Incarcerated
    • People with other mental health/ addictions issues
    • Military
    • Increasingly at risk: women
  • Mind Games & Addictions Connections
  • Mental Health/Addictions Connections
    • Depression/mood disorders
    • PTSD (studies of military veterans)
    • Impulsivity
    • ADHD
    • Substance abuse
    • Alcohol abuse
    Sources Ledgerwood & Petry (2006). Kausch et al. (2006). Biddle et al. (2005). Oregon DHS (2010). The WAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001)
    • Gambler’s fallacy
      • Failure to see EACH roll of dice or EACH spin of wheel as independent chance-related events
      • “ That slot machine is DUE to hit .”
    • Illusion of control
      • Relating winnings to skill, even in luck-based games
      • “ I’m smarter than that player.”
    • Superstition
    • Selective memory
    Cognitive Distortions   Source: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1593-604.
    • More easily hidden
    • Can’t overdose-no “saturation point”
    • Can’t be tested
    • Doesn’t require ingestion
    • Fewer resources available
    • Societal perceptions
    • Loss of control
    • Denial
    • Depression/mood swings
    • Progressive
    • First win/high remembered
    • Use as an escape
    • Preoccupation
    • Similar “highs”
    This slide courtesy Andy Cartmill, Washington County H&HS Differences Similarities ALL drugs of abuse target the brain's reward system by flooding the circuit with dopamine. What about gambling? ...
    • Still not well understood
    • Multiple neurotransmitter systems believed involved:
      • Seratonin
      • Norepinephrine (aka noradrenalin)
      • Opioid
      • Dopamine
    • Important to consider in treatment
    Source: Grant, 2006. Neurobiology and Pharmacological Treatment of Pathological Gambling.
  • Dopamine: most studied neurotransmitter in problem gambling
    • Decisions that will likely cause us to
    • lose money vs. win money
    Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC
    • Cognitive centers in flux
    • Amygdala active
      • Fight or flight, emotion
      • Decision-making altered
    • More vulnerable to risk-taking & impulsive behaviors
    • Brain especially sensitive to dopamine
    Source: Ramoski, S., Nystrom, R. (2007). “ The adolescent brain is especially sensitive to the effects of dopamine , a chemical neurotransmitter that is activated by substance use, exposure to high-intensity media, and gambling , as well as food and sex. “ 1
  • Youth: A New Social Experiment
  •  
  • Photo: Hynes, 2008
  • Photo: Hynes, 2009
  • Gambling & Oregon Teens
    • Six percent problem gamblers or at risk
    • Preferred games in order:
      • Free Internet gambling-type games
      • Cards (poker)
      • Sports bets
      • Games of personal skill
    Source: Volberg, et al (2008)
  • Addressing the Issue
  • Continuum of Care Institute of Medicine Continuum of Care Universal Selective Indicated Prevention Case I.D. Standard Tx Treatment Compliance Aftercare Maintenance
  • Prevention in Lane County inform | educate | prevent harm
  • Treatment is Free.
    • 24 hrs: 1877-my-limit
    • Online: 1877mylimit.org
  • Getting Results
    • Oregon is one of the few states that appears to have averted a significant increase in problem gambling prevalence while expanding legalized gambling.
    Source: National Center For the Study of Gambling, 2006. Source: 2. National Center For the Study of Gambling, 2006.
  • Key Challenges
    • Youthful subject
    • Perception of harmlessness
    • Stigma/shame
    • Industry
  •  
  • Name at least three typical consequences that someone may experience due to his/her gambling problem
    • Debt
    • Crime
    • Depression/Suicide
    • Relationship problems
    • Employment problems
    • Alcohol and/or drug problems
  • The average problem gambler in Oregon gambling treatment owes $4,000 in gambling-related debts.
    • The average problem gambler in Oregon gambling treatment owes $32,000 in
    • gambling-related debts.
    • Under $100
    • $100-$1,000
    $1,000-$2,500 More than $2,500
    • Problem gambling treatment is ‘free’ in Oregon for gamblers AND loved ones.
  • Wrapping it All Up
    • Gambling’s recent popularity has not come without cost
    • Many population groups are susceptible to gambling problems
    • Problem gambling has consequences similar to other addiction issues
    • Problem gambling services are free, confidential, and effective
  • Thank You!  For More Info…
    • Julie Hynes
    • Lane County Health & Human Services
    • 541.682.3928 | [email_address]
    • www.preventionlane.org/gambling
    • www.facebook.com/preventionpage
  • 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.
    • 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, TL. (2006). Oregon gambling prevalence replication study. Salem, OR: Department of Human Services. http://gamblingaddiction.org/
    • Moore (2001). Older adult gambling in Oregon . Salem, OR: Department of Human Services. http://gamblingaddiction.org
  • References
    • Northwest Survey & Data Services (2007). Lane County Health & Human Services college gambling survey. http://www.preventionlane.org/gambling/college.htm
    • Oregon Department of Human Services, Problem Gambling Services (2010). Oregon problem gambling awareness community resource guide. Salem, OR: Author.
    • 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