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LaneCare Training: Problem Gambling | 3/16/12


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Training for LaneCare providers

Training for LaneCare providers

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  • 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 Health Authority, 2010)About $7 out of every $10 was spent on video lottery games (video poker & slots)
  • 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 Health Authority, 2010)About $7 out of every $10 was spent on video lottery games (video poker & slots)
  • Equal to their annual household income.
  • Harvard researcher Christine Reilly on online gambling: "The Internet is quick and easy and offers instant gratification. It leaves you very little time to think. You just act without noting the drawbacks."
  • These are data from the 2010 Lane County Student Wellness Survey, and asks students in the 6th, 8th, and 11th grades about how much they’ve done certain behaviors in the last 30 days.Gambling is the most common problem among 8th graders and alcohol use as the most prevalent problem among 11th graders. (Gambling involves betting anything of value, e.g. money, watch, etc. Types include: lottery, dice, betting on games, bingo)Alcohol is the substance most used among all ages (8%, 22%, 41%); aside from alcohol use, 8th grade substance use runs around 10% and 11th grade substance use generally in 20-30%. *Depression= ‘Did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?’
  • “Every 15 minutes” / Grim Reaper“Scared Straight”“Just say no”All may have a temporary influence, and are quite powerful…. But do not change behavior over time.
  • Paid through Lottery fundsGambling Evaluation and Reduction Program (GEAR)Corrections Program27 outpatient treatment centers (Emergence Program in Lane County)3 crisis-respite programs1 residential treatment program
  • Of those enrolling, 87% report machine gambling as their primary choice and 74% report gambling at an Oregon retailer.Based on projections made by R. Volberg where approximately 3% of those with gambling problems should be expected to access treatment.
  • Successful completers = $3,224 per case otherwise noted this data comes from the 2011 Gambling Programs Evaluation Update (T. Moore)
  • Transcript

    • 1. addiction Michele Tantriella-Modell & Julie Hynes March 16, 2012
    • 2. Training Agenda Introductions & Expectations Overview & Trends Problem Gambling Youth Gambling & the Brain Screening & Intervention Problem Gambling Services
    • 3. $ Opportunity
    • 4. Gambling To risk money or something of value on the outcome of an unpredictable event.
    • 5. Image sources: Oregon Lottery
    • 6. Oregon Lottery Revenues
    • 7. Legal Gambling ?in Oregon Nine tribal casinos opened 1994 - 2004 Video poker began 1992 Lottery approved 1931 1984
    • 8. Gambling in Oregon Lottery  “Social gaming” (e.g.,  Scratch-its card houses)  Megabucks  Sports bets  Powerball  Horse racing  Keno  Internet  Video lottery  Office pools Bingo/charitable  Poker/card nights gaming  Bets among friends Casino gaming  Stock market (??)
    • 9. Oregon’s Spending on Gambling Oregon Lottery 2011: >$1billion 1 Lane County: per capita 2 This year… ? Sources: 1. Oregon Lottery (2011) 2. Oregon Health Authority Problem Gambling Services (2011).
    • 10. 18: Traditional Lottery games Charitable gaming Pari-mutuel betting (e.g., race track)21: Video Lottery Casinos
    • 11. 189 locations in Lane County
    • 12. Definitions PATHOLOGICAL: Persistent and recurrent maladaptive gambling behavior...results in the “PATHOLOGICAL GAMBLING” LOSS OF CONTROL over gambling. (DSM-IV)also called“compulsive gambling” or“gambling addiction”
    • 13. Gambling on a Continuum No Social At-Risk Problem Pathological Gambling Experimentation~74,000 Oregon adults “problem gamblers” (2.7%)Source: Moore, TL. (2006). Oregon Gambling Prevalence Replication Study.
    • 14. Three Core “Phases” Winning LosingHitting “Bottom” Desperation Crime Divorce Desperation Depression/Suicide Getting help? Source: Custer, R. (1980). “Custer Three Phase Model.”
    • 15. Signs: Pathological Gambling (DSM-IV Criteria)1. Preoccupation with 6. “Chases” losses gambling 7. Lies to others to conceal2. Increases amount of gambling money gambled 8. Has committed illegal3. Unsuccessfully tries to acts quit 9. Has jeopardized4. Restless or irritable when relationships trying to cut down/stop 10. Relies on others to bail5. Gambles as an escape him/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).
    • 16. Most Common Effects ofProblem Gambling Average debt - $33,342: Crime – 25% Depression/suicide  48% seriously considered suicide  9% attempted suicide Relationship jeopardized/lost – 35% Concurrent alcohol problems – 34% Concurrent other drug problems – 15%Source: Oregon Health Authority, 2011
    • 17. Social & Economic Costs $469 million: Estimated annual social cost to Oregonians Costs include: • Criminal justice • Unemployment • Legal fees • Other social services • Bankruptcies (e.g., TANF, SNAP) • Divorces • Medical fees/ Hospitalization (Depressive/suicide attempts)
    • 18. Mental Health/Addictions Connections  Depression/mood disorders  Narcissistic personality disorder  PTSD  Impulsivity  ADHD  Alcohol & other drug abuseSources Ledgerwood & Petry (2006). Kausch et al. (2006). Biddle et al. (2005). Oregon Health Authority (2011). TheWAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001)
    • 19. In Perspective
    • 20. Gambling’s “Crack Cocaine”? 9 in 10 problem gamblersSource: Oregon Health Authority (2011). Oregon Gambling Treatment Programs Evaluation Update.
    • 21. Mental Health or Addiction?Addiction? Mental health?DSM-V (pending) PG classified as Impulse Disorder in DSM-IVA&D type Cognitive/tx approach Behavioral approach to(e.g., GA) treatmentCo-occurrence with alcohol/drug Co-occurrence with otheraddiction MH disorders
    • 22. Addiction ConnectionSimilarities Differences Loss of control  More easily hidden Denial  Can’t overdose-no Depression/mood swings “saturation point” Progressive  Can’t be tested First win/high remembered  Doesn’t require ingestion Use as an escape  Societal perceptions/shame Preoccupation Similar “highs” Slide adapted from Washington County H&HS
    • 23. UO 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 substance addiction.
    • 24. Cognitive Distortions • Gambler’s fallacy • Illusion of control • Superstition • Selective memorySource: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1593-604.
    • 25. Potential NeurotransmitterRoles in PG Role in ImpulseNeurotransmitter Control Serotonin  Serotonin -- risk taking Behavior Initiation/Cessation Norepinephrine  NE levels PGs -Arousal, Excitement Opioids Gambling -  β-endorphin Pleasure, Urges Dopamine PGs -  dopamine response Reward, Reinforcement Dopamine: most studied neurotransmitter in problem gambling
    • 26. Different Types of Gambling =Different Experiences Lottery scratch-offs: tend to be high on “anticipation & fantasy” Video poker and slots: tend to be high on “escape” Craps & sports betting: tend to be high on “excitement”
    • 27. Vulnerable Populations Older adults College students Ethnic minorities Incarcerated persons In the interest of time, Military & veterans we will be focusing on Women SA history youth today. MH history Youth
    • 28. Effects on Children  Higher abuse & neglect  Higher rates of pathological gambling among teens  Higher levels of tobacco, alcohol & other drug use, & overeatingSources: 1. National Opinion Research Center (1999). 2. Darbyshire, Oster, & Carrig (2001). 3. Gupta & Derevensky (1997);Jacobs (2000); Wallisch & Liu (1996). 4 Volberg et al. (2008; ibid).
    • 29. “The earlier people begingambling, the more likelythey are to experienceproblems from gambling.”- National Academy of Sciences
    • 30. Not Your Uncle’s GamblingResearchon: Youth gambling still under-studied & under the radar
    • 31. Gambling & Oregon Teens Six in 10 Oregon (63 percent) have gambled 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 games  Cards (poker)  Sports bets  Games of personal skill Source: Volberg, et al (2008; bid).
    • 32. 2010 Lane County StudentWellness Survey
    • 33. Risk Factors  Single-parent household  Started gambling before  Gambling on cards/sports 8th grade (early  Being male, older teen initiation)  Lower household income  Parents who gamble-- youth twice as likely to  Competitive be at-risk gamblers &  Having lost more than four times as likely to be $50 in a single month problem gamblersSource: Volberg, et al (2008; bid).
    • 34. Continuum of CareInstitute of Medicine Continuum of Care
    • 35. Examples in Lane County
    • 36. Results Prevention and awareness efforts in Oregon have been able to avert an increase in the prevalence while facing a dramatic increase in the availability of gambling opportunities. Local efforts have provided prevention and awareness information to an estimated 1.3 million Oregonians.
    • 37. Continuum of CareInstitute of Medicine Continuum of Care
    • 38. Identification: Telling theDifference Social Gambler Problem Gambler Occasional Frequent, preoccupied Sticks w/ limits Plays w/needed $, borrows Hopes to win, expects Hopes & expects to WIN to lose Can take it or leave it Primary source of “fun”
    • 39. Intervention Helpline 541.741.7107: emergence Or 24/7: 1.877.MY.LIMIT Referred to provider for assessment Family members come in; later bring gambler in
    • 40. Screening: The “Lie-Bet” Two questions to rule out pathological gambling behavior  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? One or both “yes” answers indicate further assessment needed  Further evaluation can be made by calling 1-877-MY-LIMIT
    • 41. 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)
    • 42. DSM-IV Criteria Revisited1. Preoccupation with 6. “Chases” losses gambling 7. Lies to others to conceal2. Increases amount of gambling money gambled 8. Has committed illegal3. Unsuccessfully tries to quit acts4. Restless or irritable 9. Has jeopardized when trying to cut relationships down/stop 10. Relies on others to bail5. Gambles as an escape him/her out Pathological Gambling = Five or more of above, AND: The gambling behavior is not better accounted for by a Manic Episode.
    • 43. Continuum of CareInstitute of Medicine Continuum of Care
    • 44. Treatment is Free. 24 hrs: 1877-my-limit Online:
    • 45. Treatment Options in Oregon Minimal intervention: GEAR (Gambling Education and Reduction) Outpatient treatment (27) Crisis respite (2) Residential treatment (1)
    • 46. 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 - Recreational counseling  Didactic lectures - Audiovisual educ.  Suggest to explore 12-step program
    • 47. Other Facts onGambling Treatment in Oregon Only about 2% of Oregonians who need treatment enroll With unstable funding, enrollments dropped 20% in the past year Those enrolling who lived within a 50 mile radius of a casino were significantly more likely to report casino as their primary venue 30% enter treatment through the state-wide helpline
    • 48. 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.
    • 49. Wrapping it All Up Gambling’s recent popularity has not come without cost Gambling problems often mimic other disorders in manifestation, consequences, & co-occurrence Various populations are at risk Problem gambling services are free, confidential, available and effective Important to assess for issue & make your clients aware of services
    • 50. Q&A, Evaluations Thank You!!
    • 51. For More Info…Michele Tantriella-Modell Julie HynesMS, LPC, CADC, NCGC II MA, CPSProgram Director Community Health AnalystEmergence Meridian Gambling Lane County H&HSTreatment Program Prevention Program541.741.7107