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GAMBLING
Julie Hynes, Sr. Community Health Analyst
Lane County Public Health
SAPP 407 | University of Oregon | Feb. 2014
OVERVIEW
• History & trends  
• Defining the issue: problem gambling
• Gambling & the brain
• Addiction & mental health co...
POTENTIAL
DEFINITION:
______ something of value
RISKING
in the hopes of obtaining
_________________
something of greater
value.
Sour...
How
quickly
things
are
changing
Source: insidefacebook.com
Source: WSJ.com 2/11/14
GAMING & GAMBLING:
PARALLELS
Stimulate dopamine
Play for similar reasons (escape, relax, 
stimulate, etc.)
Potential for a...
Anything

can be a bet…
(especially
online!)

Sources: linemakers.sportingnews.com, bovada.lv
What are the 2 states that
DON’T have
legalized gambling?
AVAILABILITY OF LEGAL
GAMBLING IN U.S., 2014
Nine tribal casinos opened

1994 - 2004
Video poker began

Horsetrack
1931

Lottery approved

1984

1992
Image sources: Oregon Lottery, Hynes
Image sources: Oregon Lottery, Hynes
ELECTRONIC GAMBLING:
“Video Poker/Slots/Line Games”

7

$ out
of every

Photo source: Daniel Berman.

$10
lottery
dollars
...
Photo:  Hynes
Photo:  Daniel Berman
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 ...
So…if your lucky numbers
have “almost” come up in the
last 5 drawings, are your
chances better, worse, or the
same?
Sports bets
Lottery tickets
Video & online
Bingo & raffles
Gambling Treatment Clients
Gamblers' Preferences

Video lottery  
& online gambling

Electronic
Gambling
89%

Cards
6%
Oth...
Research shows about what
percentage of Oregon
adults have a gambling
problem?
0.1%
11.2%

1.2%
2.7%
2.7% of Oregon adults
(1 in 37 people)
have a gambling problem.
Behind every story…
there’s a story…
Definitions

PATHOLOGICAL:
Persistent and recurrent 
maladaptive gambling 
behavior...results in the   
LOSS OF CONTROL ov...
New

language
GAMBLING
DOESN’T START

BY BEING A
PROBLEM.
It’s a

No
Gambling

Recreational
Experimentation

“Continuum”

At-Risk

Problem

Pathological

“GAMBLING DISORDER”

Sourc...
This is the first 
generation of 
widely available 
electronic 
gambling. 
We really don’t 
know the effects 
yet.

5.6% c...
The new DSM-5 (May 2013) defines
pathological gambling as a

“behavioral addiction,”
the first of its kind.
SIMILAR BEHAVIORAL CONDITIONS, like internet and
Binge eating, aren’t yet in the category of

“behavioral addiction.”
(It ...
IS IT AN “ADDICTION”
1. Solidly established, problematic pattern of a 
pleasurable & reinforcing behavior
2. Physiological...
IS SOMEONE YOU KNOW…
• Gambling to escape problems
• "Chasing" losses with more gambling
• Lying to family and others abou...
EXAMPLES
REAL LIFE‐ in the news
http://www.oregonlive.com/portland/index.ssf/2013/06/former_postal_service_worker_s.html
Register‐Guard, 5/13/11
But really, the consequences are 
usually much more than crime and 
being in the news…
THE STORIES GO ON.

…each problem gambler affects an
average of 6‐12 others.
>70%

48%

are current 
tobacco users

experience 
suicidal ideation

10%

32%
have current 
alcohol 
problems

Source: Or...
10:49PM

Jordan SAPP
5:11PM

Hey man we r here @ 
starbucks on 13th c u soon
running late sorry
It’s been 2 more hrs.  U 
...
PROCESS of
ADDICTION.
Typical Phases of
Problem Gambling
LOSING

WINNING

HOPELESSNESS

DESPERATION

Source: Custer, R. & Rosenthal, M.
Winning PHASE
Losing PHASE
I’ll get my
money back in
no time.
My big win is
just around the
corner!
Desperation PHASE
Hopelessness PHASE
THOUGHTS, FEELINGS,
ANTICIPATION,
FANTASY

REALITY

(Gambler’s Mind,
“Gambling Time/
Gambling Money”)

(Self with Others)
...
WHAT CAN TRIGGER ACTION?
Lots of things, but these are some key triggers. 
People at risk should especially avoid gambling...
Comparison by
Start gambling
younger

Start gambling at
older age than men

Tend to like games of
strategy & “action”
(pok...
Oregonians in gambling treatment, 2012:

32k

$

IS THE AVERAGE HOUSEHOLD INCOME. 
Range is from $0 to over $1million/year...
Comparison of “Action” and
“Escape” Pathological
Gamblers

Action

Escape

Excitement, competition

Relief, escape from st...
CAUSES? (RISK FACTORS)
• Trauma -stemming from
abuse or neglect
• Mental health
issues
• Substance use
• Parental
attitude...
At what age is the

brain considered
fully developed?
 18

 21

 25

 16
The brain
is still
developing
until

The PREFRONTAL

CORTEX is the
LAST PART to
develop.
 Depression/mood disorders 

 Narcissistic personality disorder
 PTSD  

 Impulsivity
 ADHD
 Substance abuse 
 Alco...
It’s really about the
action, not the money!
“ALMOST 
WINNING” 
causes 
dopamine to 
be activated 
the same as 
ACTUALLY 
...
Neurotransmitter
“PGs” = problem gamblers | Neurotransmitters are brain chemicals that 
transmit nerve impulses. Dopamine ...
Gambling & Dopamine
It’s not about the money – it’s about the action of the game and the hope of 
winning.  

Dopamine not...
Sources: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1
Anecdotal repo...
COGNITIVE Distortions

Superstition

Lucky #’s
Favorite shirt
“My” machine
Image source: Anheuser‐Busch

Rituals/habits th...
COGNITIVE Distortions

Biased Evaluation
Attributing wins to one’s special
skill or luck, while losses are
blamed on exter...
COGNITIVE Distortions

Selective Memory
Forgetting about losses, only
remembering wins.
Image source: Anheuser‐Busch
COGNITIVE Distortions

Gambler’s Fallacy
Failure to see each event as independent.
Examples:
• Trying to see patterns in c...
THIS

…those are other ways our

minds trick us. We are wired to
see patterns in things.
Reflect: cognitive distortion
Have you ever
experienced a
cognitive distortion?
What was the
experience like?
VULNERABLE POPULATIONS
Older adults
• Substance abuse 
history
College students
Ethnic minorities • Mental health 
history...
The “Addiction” Connection
Similarities?

Differences?
The “Addiction” Connection
Similarities?
•
•
•
•
•
•
•
•
•
•
•

Loss of control
Denial
Depression/mood swings
Progressive
...
Effects of Problem Gambling on
Children
• Prone to abuse and/or neglect
• Child endangerment may increase
• Higher levels ...
“The earlier people begin
gambling, the more likely
they are to experience
problems from gambling.”
- National Academy of ...
Not Your Uncle’s
Gambling

Research
on:

Youth gambling still under-studied & under the radar
•Amygdala active  
•Fight or flight,
emotion
•Decision-making
altered
•More vulnerable to risk‐
taking & impulsive 
behavi...
RISK FACTORS FOR YOUTH
• Single‐parent household • Started gambling before 
8th grade (early 
• Gambling on 
initiation)
c...
Gambling & Oregon Teens
Six in 10 Oregon (63 percent) have gambled
46 percent gambled in the past year
3 percent gamble we...
Lane County 2012
Student Wellness Survey (SWS)
2012 Gambling, Substance Use and Mental Health 
among Oregon Youth
50%
Perc...
Used alcohol in the past month
100%
90%
80%
70%

Percentage

60%
50%

Did not gamble

40%

Gambled

30%
20%
10%
0%

Grade ...
Binge drank in the last 30 days
50%
45%
40%

Percentage

35%
30%

Did not gamble
Gambled

25%
20%
15%
10%
5%
0%

Grade 6

...
Smoked cigarettes in the past
month
50%
45%
40%

Percentage

35%
30%

Did not gamble
Gambled

25%
20%
15%
10%
5%
0%

Grade...
Used marijuana in the past month

50%
45%
40%

Percentage

35%
30%
25%

Did not gamble

20%

Gambled

15%
10%
5%
0%

Grade...
Percentage

Skipped school one or more days
in the past month

50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%

Did not gamble
G...
Percent of youth who
attempted suicide in the
past year

30%
Percentage

25%
20%
Did not gamble

15%
10%

11.3%
7.2%

5%

...
Percent of youth that attempted
suicide in the past year

30%
Percentage

25%

21.0%

18.6%

20%
15%
10%

10.1%

Did not
b...
Conclusion?

Teens who gamble are 
smoked up, toked up, 
drunk emo delinquents.
Conclusion?

Teens who gamble are 
smoked up, toked up, 
drunk emo delinquents.
Conclusion: Problem Gambling
is
ONE COMPONENT of
Problem Behaviors
delinquency

sexual
behavior

Problem
depression
Behavi...
Identification & Treatment
Online: click here

Source: Written by Robert L. Custer, M.D; retrieved from Council on Compulsive Gambling of New Jersey,...
Intervention
Helpline 
541.741.7107:
emergence
Or 24/7: 1.877.MY.LIMIT

Referred to provider for 
assessment
Family member...
A Simple Screen: Lie-Bet Tool
(Johnson et al., 1988)

1.Have you ever felt the need to bet
more and more money?
2.Have you...
Assessment Tools
SOGS
DSM
DSM Criteria Revisited
1.
2.
3.
4.

5.

Preoccupation
with gambling
Increases amount
of money gambled
Unsuccessfully
tries...
Treatment is Free.

24 hrs: 1877‐my‐limit
Online: 1877mylimit.org
TREATMENT OPTIONS IN OREGON
Minimal intervention: 
GEAR (Gambling 
Education and Reduction)
Outpatient treatment (44)
Cris...
EMERGENCE GAMBLING
TREATMENT PROGRAM
Treatment free for gamblers and loved ones
275 problem gamblers and family members
tr...
• Only about 2% of Oregonians who need treatment 
enroll 
• Those enrolling who lived within a 50 mile radius 
of a casino...
THOUGHTS, FEELINGS,
ANTICIPATION,
FANTASY

REALITY

(Gambler’s Mind,
“Gambling Time/
Gambling Money”)

(Self with Others)
...
DISRUPTING THE ACTION
CYCLE
•
•
•
•
•

Barriers to Money
Treatment
Support Systems
Accountability
H.A.L.T. (hungry, angry,...
FAMILY TREATMENT ISSUES
•
•
•
•
•
•
•
•

Allow venting of rage and betrayal
Education of compulsive gambling as an illness...
Family Financial Issues
• Create own avenue to financial stability 
(employment or other)
• Protect financial assets
• Clo...
Couple Issues in Therapy







Sequencing with individual work 
Assess possibility of domestic violence
Impact on p...
Promotion & Prevention
Creating conditions in families, 
schools, and communities that

promote the wellbeing
of people
Emotional and behavioral
...
Awareness & communication of
the problem is relatively low.

2012 Oregon Student Wellness Survey, Lane County (“Esd”) and ...
Targeting Parental Attitudes
Oregon parent/youth focus groups revealed:

• All parents in the groups said their kids 
didn...
Targeting Parental Attitudes

Most parents believe:
• Youth gambling is harmless 
• Youth who gamble are unlikely to have ...
Crashed cars
“Scared straight”
Boot camp
One‐time activities
Our efforts in
Oregon have
• Public awareness
a focus on:
• Policy
• Support for in‐
school prevention 
curriculum
• Paren...
Problem Gambling
Advisory Committee
• Meets monthly
• Works on policy & 
awareness issues
• Comprised of 
professionals & ...
Various Methods
ON THE
RIGHT PATH
KEY CHALLENGES IN THE
FIELD
• Youthful subject
• Perception of 
harmlessness
• Stigma/shame
• Industry
IS IT “SOCIAL” OR PROBLEM
GAMBLING?

Social Gambler

Problem Gambler

Occasional

Frequent, preoccupied

Sticks w/ limits
...
10 TIPS FOR RESPONSIBLE
GAMBLING
1. Gamble only if it's fun.
2. Think of the money you lose as the cost of 
entertainment....
10 TIPS FOR RESPONSIBLE
GAMBLING
6. Don't borrow money to gamble.
7. Don't let gambling interfere with family, friends, 
o...
SUMMARIZING THIS CONTENT
•
•
•
•
•
•

We defined gambling & problem gambling
We looked at trends
We looked at connections ...
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.
The average problem
gambler in Oregon
gambling treatment owes

$4,000 in

gambling-related debts.
The average problem gambler in 
Oregon gambling treatment owes 

$30,000 in 
gambling‐related debts.
preventionlane.org

facebook.com/
preventionlane

twitter.com/
preventionlane
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
UO Addictive Behaviors: Disordered Gambling
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UO Addictive Behaviors: Disordered Gambling

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Transcript of "UO Addictive Behaviors: Disordered Gambling"

  1. 1. GAMBLING Julie Hynes, Sr. Community Health Analyst Lane County Public Health SAPP 407 | University of Oregon | Feb. 2014
  2. 2. OVERVIEW • History & trends   • Defining the issue: problem gambling • Gambling & the brain • Addiction & mental health connections • Addressing the issue
  3. 3. POTENTIAL
  4. 4. DEFINITION: ______ something of value RISKING in the hopes of obtaining _________________ something of greater value. Source: American Psychiatric Association ‐ DSM‐5 (2013). 
  5. 5. How quickly things are changing Source: insidefacebook.com
  6. 6. Source: WSJ.com 2/11/14
  7. 7. GAMING & GAMBLING: PARALLELS Stimulate dopamine Play for similar reasons (escape, relax,  stimulate, etc.) Potential for addiction?
  8. 8. Anything can be a bet… (especially online!) Sources: linemakers.sportingnews.com, bovada.lv
  9. 9. What are the 2 states that DON’T have legalized gambling?
  10. 10. AVAILABILITY OF LEGAL GAMBLING IN U.S., 2014
  11. 11. Nine tribal casinos opened 1994 - 2004 Video poker began Horsetrack 1931 Lottery approved 1984 1992
  12. 12. Image sources: Oregon Lottery, Hynes
  13. 13. Image sources: Oregon Lottery, Hynes
  14. 14. ELECTRONIC GAMBLING: “Video Poker/Slots/Line Games” 7 $ out of every Photo source: Daniel Berman. $10 lottery dollars Source: Oregon Health Authority  (2012; ibid)
  15. 15. Photo:  Hynes
  16. 16. Photo:  Daniel Berman
  17. 17. 1 in 175 1 in 175,000 1 in 175 million 1 in 175 billion
  18. 18. 1 in 175 Million (174,233,510) Odds of getting struck by lightning: 1 in 280,000
  19. 19. 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
  20. 20. So…if your lucky numbers have “almost” come up in the last 5 drawings, are your chances better, worse, or the same?
  21. 21. Sports bets Lottery tickets Video & online Bingo & raffles
  22. 22. Gambling Treatment Clients Gamblers' Preferences Video lottery   & online gambling Electronic Gambling 89% Cards 6% Other 5%
  23. 23. Research shows about what percentage of Oregon adults have a gambling problem? 0.1% 11.2% 1.2% 2.7%
  24. 24. 2.7% of Oregon adults (1 in 37 people) have a gambling problem.
  25. 25. Behind every story… there’s a story…
  26. 26. Definitions PATHOLOGICAL: Persistent and recurrent  maladaptive gambling  behavior...results in the    LOSS OF CONTROL over      gambling. (DSM‐IV)
  27. 27. New language
  28. 28. GAMBLING DOESN’T START BY BEING A PROBLEM.
  29. 29. It’s a No Gambling Recreational Experimentation “Continuum” At-Risk Problem Pathological “GAMBLING DISORDER” Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3.  Shaffer & Hall (2001). 4. Northwest Survey & Data  Services (2007). 5. Moore (2001). 
  30. 30. This is the first  generation of  widely available  electronic  gambling.  We really don’t  know the effects  yet. 5.6% college age (18‐24) 4% teens (13‐17) 2½ % all adults (18+)
  31. 31. The new DSM-5 (May 2013) defines pathological gambling as a “behavioral addiction,” the first of its kind.
  32. 32. SIMILAR BEHAVIORAL CONDITIONS, like internet and Binge eating, aren’t yet in the category of “behavioral addiction.” (It is thought They might be soon.)
  33. 33. IS IT AN “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
  34. 34. IS SOMEONE YOU KNOW… • Gambling to escape problems • "Chasing" losses with more gambling • Lying to family and others about the extent of gambling • Committing crimes to finance gambling • Jeopardizing or losing relationships, jobs, education because of gambling • Relying on others to bail him or her out relieve a desperate financial situation caused by gambling
  35. 35. EXAMPLES REAL LIFE‐ in the news
  36. 36. http://www.oregonlive.com/portland/index.ssf/2013/06/former_postal_service_worker_s.html
  37. 37. Register‐Guard, 5/13/11
  38. 38. But really, the consequences are  usually much more than crime and  being in the news…
  39. 39. THE STORIES GO ON. …each problem gambler affects an average of 6‐12 others.
  40. 40. >70% 48% are current  tobacco users experience  suicidal ideation 10% 32% have current  alcohol  problems Source: Oregon Health Authority, 2012 actually attempt  suicide Have current  drug problems
  41. 41. 10:49PM Jordan SAPP 5:11PM Hey man we r here @  starbucks on 13th c u soon running late sorry It’s been 2 more hrs.  U  coming or what? on my way … Never mind. We finished  the project. AGAIN. Sorry but  the group is done w/your  excuses.
  42. 42. PROCESS of ADDICTION.
  43. 43. Typical Phases of Problem Gambling LOSING WINNING HOPELESSNESS DESPERATION Source: Custer, R. & Rosenthal, M.
  44. 44. Winning PHASE
  45. 45. Losing PHASE I’ll get my money back in no time. My big win is just around the corner!
  46. 46. Desperation PHASE
  47. 47. Hopelessness PHASE
  48. 48. THOUGHTS, FEELINGS, ANTICIPATION, FANTASY REALITY (Gambler’s Mind, “Gambling Time/ Gambling Money”) (Self with Others) “Real Time, Real Money” CRASH Guilt, Shame, Anger, Denial, Justification, Restless, Irritable, Depression, Panic or Numb, Suicidal Thoughts Dopamine PLANNING (Removing obstacles to gambling) GAMBLING (“Winning & Losing”) Serotonin Adrenaline Dopamine Source: http://www.oregon.gov/oha/amh/gambling/gear‐workbook.pdf
  49. 49. WHAT CAN TRIGGER ACTION? Lots of things, but these are some key triggers.  People at risk should especially avoid gambling when: H ungry A ngry L onely Tired
  50. 50. Comparison by Start gambling younger Start gambling at older age than men Tend to like games of strategy & “action” (poker, sports bets) Get addicted faster Less likely to seek help Games of choice: video slots More likely to be “escape” gamblers These comparisons are of course generalizations and do not by  any means reflect all male and female gamblers.
  51. 51. Oregonians in gambling treatment, 2012: 32k $ IS THE AVERAGE HOUSEHOLD INCOME.  Range is from $0 to over $1million/year. 85% ARE WHITE .  4.4% Hispanic/Latino., 3.4% Asian.   People of color are under‐represented in treatment. 90% prefer ELECTRONIC GAMBLING.  24% HAVE COMMITTED CRIMES TO FINANCE  THEIR GAMBLING. Most crimes are “white collar”  Video (slots/poker/line games).  Cards 4.1%; scratch‐its 1.3%; sports 0.9%; (forgery, check fraud, embezzlement.) $! 27k $ IS THE AVERAGE INDIVIDUAL GAMBLING  DEBT.
  52. 52. Comparison of “Action” and “Escape” Pathological Gamblers Action Escape Excitement, competition Relief, escape from stress “Skilled” forms of gambling  (sports/poker, etc) “Luck” forms of gambling  (lottery, slots, bingo) Early onset of gambling Later onset of gambling More likely to present  narcissistic or antisocial traits More likely to present depressive/dysthymic traits Source: Center for Substance Abuse Treatment, 2005. 
  53. 53. 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
  54. 54. At what age is the brain considered fully developed?  18  21  25  16
  55. 55. The brain is still developing until The PREFRONTAL CORTEX is the LAST PART to develop.
  56. 56.  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)
  57. 57. It’s really about the action, not the money! “ALMOST  WINNING”  causes  dopamine to  be activated  the same as  ACTUALLY  winning. People play  LONGER  when  machines  give them  NEAR  MISSES. Problem  gamblers are  more likely to  see their near  misses as  “NEAR WINS” For more info: see article  “The Almost Winning Addiction” in the readings.
  58. 58. Neurotransmitter “PGs” = problem gamblers | Neurotransmitters are brain chemicals that  transmit nerve impulses. Dopamine is known as the brain’s “reward system.” Neurotransmitter Role in Relation to Gambling Serotonin  Serotonin --  risk taking Behavior Initiation/Cessation Norepinephrine PGs Arousal,levels -   NE Excitement Opioids Pleasure, Urges Gambling -   β-endorphin Dopamine PGs -   dopamine response Reward, Reinforcement Dopamine: most studied neurotransmitter in problem gambling
  59. 59. Gambling & Dopamine It’s not about the money – it’s about the action of the game and the hope of  winning.   Dopamine not released when expecting a loss. Flooded with dopamine when expecting a win! Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC
  60. 60. Sources: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1 Anecdotal reports from problem gamblers in treatment and recovery.
  61. 61. COGNITIVE Distortions Superstition Lucky #’s Favorite shirt “My” machine Image source: Anheuser‐Busch Rituals/habits that are believed to affect the outcome.
  62. 62. COGNITIVE Distortions Biased Evaluation Attributing wins to one’s special skill or luck, while losses are blamed on external circumstances. Example (win): “Yeah buddy! I was just waiting on my  card. I know this game inside and out.” Example (loss): “I would’ve won if that idiot didn’t get  lucky and draw an ace.”
  63. 63. COGNITIVE Distortions Selective Memory Forgetting about losses, only remembering wins. Image source: Anheuser‐Busch
  64. 64. COGNITIVE Distortions Gambler’s Fallacy Failure to see each event as independent. Examples: • Trying to see patterns in coin flips. • “This slot machine is DUE to hit!”
  65. 65. THIS …those are other ways our minds trick us. We are wired to see patterns in things.
  66. 66. Reflect: cognitive distortion Have you ever experienced a cognitive distortion? What was the experience like?
  67. 67. VULNERABLE POPULATIONS Older adults • Substance abuse  history College students Ethnic minorities • Mental health  history Incarcerated  • Youth persons • Military & veterans • Women • • • •
  68. 68. The “Addiction” Connection Similarities? Differences?
  69. 69. The “Addiction” Connection Similarities? • • • • • • • • • • • 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?  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
  70. 70. 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
  71. 71. “The earlier people begin gambling, the more likely they are to experience problems from gambling.” - National Academy of Sciences
  72. 72. Not Your Uncle’s Gambling Research on: Youth gambling still under-studied & under the radar
  73. 73. •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.
  74. 74. RISK FACTORS FOR YOUTH • Single‐parent household • Started gambling before  8th grade (early  • Gambling on  initiation) cards/sports • Being male, older teen • Parents who gamble‐‐ youth twice as likely to  • Lower household  be at‐risk gamblers &  income four times as likely to be  • Competitive problem gamblers • Having lost more than  $50 in a single month Source: Volberg, et al (2008; bid).
  75. 75. 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).
  76. 76. Lane County 2012 Student Wellness Survey (SWS) 2012 Gambling, Substance Use and Mental Health  among Oregon Youth 50% Percentage 40% 6th 30% 11th 20% 10% 0% Gambling Alcohol Binge Marijuana Cigarettes Depression Psych Alcohol distress 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)  8th
  77. 77. Used alcohol in the past month 100% 90% 80% 70% Percentage 60% 50% Did not gamble 40% Gambled 30% 20% 10% 0% Grade 6 Grade 8 Available at: www.preventionlane.org/sws.htm Grade 11
  78. 78. Binge drank in the last 30 days 50% 45% 40% Percentage 35% 30% Did not gamble Gambled 25% 20% 15% 10% 5% 0% Grade 6 Grade 8 Available at: www.preventionlane.org/sws.htm Grade 11
  79. 79. Smoked cigarettes in the past month 50% 45% 40% Percentage 35% 30% Did not gamble Gambled 25% 20% 15% 10% 5% 0% Grade 6 Grade 8 Available at: www.preventionlane.org/sws.htm Grade 11
  80. 80. Used marijuana in the past month 50% 45% 40% Percentage 35% 30% 25% Did not gamble 20% Gambled 15% 10% 5% 0% Grade 6 Grade 8 Available at: www.preventionlane.org/sws.htm Grade 11
  81. 81. Percentage Skipped school one or more days in the past month 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Did not gamble Gambled Grade 6 Grade 8 Available at: www.preventionlane.org/sws.htm Grade 11
  82. 82. Percent of youth who attempted suicide in the past year 30% Percentage 25% 20% Did not gamble 15% 10% 11.3% 7.2% 5% 9.0% 5.0% 0% Grade 8 Available at: www.preventionlane.org/sws.htm Grade 11 Gambled
  83. 83. Percent of youth that attempted suicide in the past year 30% Percentage 25% 21.0% 18.6% 20% 15% 10% 10.1% Did not bet/gamble more than wanted to 8.0% Bet/gambled more than wanted to 5% 0% Grade 8 Grade 11
  84. 84. Conclusion? Teens who gamble are  smoked up, toked up,  drunk emo delinquents.
  85. 85. Conclusion? Teens who gamble are  smoked up, toked up,  drunk emo delinquents.
  86. 86. Conclusion: Problem Gambling is ONE COMPONENT of Problem Behaviors delinquency sexual behavior Problem depression Behaviors gambling substance use
  87. 87. Identification & Treatment
  88. 88. Online: click here Source: Written by Robert L. Custer, M.D; retrieved from Council on Compulsive Gambling of New Jersey, Inc..
  89. 89. 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
  90. 90. A Simple Screen: Lie-Bet 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
  91. 91. Assessment Tools SOGS DSM
  92. 92. DSM Criteria Revisited 1. 2. 3. 4. 5. 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 6. 7. 8. 9. “Chases” losses Lies to others to conceal gambling Has jeopardized relationships Relies on others to bail him/her out Gambling Disorder = Four or more of above, AND: The gambling behavior is not better accounted for by a Manic Episode.
  93. 93. Treatment is Free. 24 hrs: 1877‐my‐limit Online: 1877mylimit.org
  94. 94. TREATMENT OPTIONS IN OREGON Minimal intervention:  GEAR (Gambling  Education and Reduction) Outpatient treatment (44) Crisis respite (2) Residential treatment (1)
  95. 95. EMERGENCE GAMBLING TREATMENT PROGRAM Treatment free for gamblers and loved ones 275 problem gamblers and family members treated last year Gender-specific Multimodal treatment  Individual sessions therapy Group sessions counseling Didactic lectures - Family - Recreational - Audiovisual educ. Suggest to explore 12‐step program
  96. 96. • Only about 2% of Oregonians who need treatment  enroll  • 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 statewide  helpline
  97. 97. THOUGHTS, FEELINGS, ANTICIPATION, FANTASY REALITY (Gambler’s Mind, “Gambling Time/ Gambling Money”) (Self with Others) “Real Time, Real Money” CRASH Guilt, Shame, Anger, Denial, Justification, Restless, Irritable, Depression, Panic or Numb, Suicidal Thoughts Dopamine PLANNING (Removing obstacles to gambling) GAMBLING (“Winning & Losing”) Serotonin Adrenaline Dopamine Source: http://www.oregon.gov/oha/amh/gambling/gear‐workbook.pdf
  98. 98. DISRUPTING THE ACTION CYCLE • • • • • Barriers to Money Treatment Support Systems Accountability H.A.L.T. (hungry, angry, lonely, tired) Slide credit: Janese Olalde, MEd, CGAC, CADC
  99. 99. FAMILY TREATMENT ISSUES • • • • • • • • Allow venting of rage and betrayal Education of compulsive gambling as an illness Family Groups Renew sense of hope Empowerment Seek support – treatment  GAM‐ANON DON’T KEEP SECRETS! Slide credit: Janese Olalde, MEd, CGAC, CADC
  100. 100. Family Financial Issues • Create own avenue to financial stability  (employment or other) • Protect financial assets • Close joint accounts • Use automatic/electronic  deposits for gambler’s income • NO BAILOUTS!  Slide credit: Janese Olalde, MEd, CGAC, CADC
  101. 101. Couple Issues in Therapy       Sequencing with individual work  Assess possibility of domestic violence Impact on partner and children  Role of money in the relationship  Deal with hurt, anger, mistrust Dealing with “unfolding truths” Slide credit: Janese Olalde, MEd, CGAC, CADC
  102. 102. Promotion & Prevention
  103. 103. Creating conditions in families,  schools, and communities that promote the wellbeing of people Emotional and behavioral health Physical health
  104. 104. Awareness & communication of the problem is relatively low. 2012 Oregon Student Wellness Survey, Lane County (“Esd”) and Oregon;  available at http://oregon.pridesurveys.com/esds.php?year=2011
  105. 105. Targeting Parental Attitudes Oregon parent/youth focus groups revealed: • All parents in the groups said their kids  didn’t gamble • All kids in the groups said they did gamble • Neither sees gambling as risky
  106. 106. Targeting Parental Attitudes Most parents believe: • Youth gambling is harmless  • Youth who gamble are unlikely to have  problems in school • Youth gambling is not associated with alcohol  or drug use …and those beliefs are part of the problem
  107. 107. Crashed cars “Scared straight” Boot camp One‐time activities
  108. 108. Our efforts in Oregon have • Public awareness a focus on: • Policy • Support for in‐ school prevention  curriculum • Parent education
  109. 109. Problem Gambling Advisory Committee • Meets monthly • Works on policy &  awareness issues • Comprised of  professionals &  community  members
  110. 110. Various Methods
  111. 111. ON THE RIGHT PATH
  112. 112. KEY CHALLENGES IN THE FIELD • Youthful subject • Perception of  harmlessness • Stigma/shame • Industry
  113. 113. IS IT “SOCIAL” OR PROBLEM GAMBLING? Social Gambler Problem Gambler Occasional Frequent, preoccupied Sticks w/ limits Plays w/needed $, borrows Hopes to win, expects to lose Hopes & expects to WIN Can take it or leave it Primary source of “fun”
  114. 114. 10 TIPS FOR RESPONSIBLE GAMBLING 1. Gamble only if it's fun. 2. Think of the money you lose as the cost of  entertainment. 3. Set a dollar limit and stick to it. 4. Set a time limit and stick to it. 5. Accept losing as part of the game.
  115. 115. 10 TIPS FOR RESPONSIBLE GAMBLING 6. Don't borrow money to gamble. 7. Don't let gambling interfere with family, friends,  or work. 8. Don't gamble to win back losses. 9. Don't use gambling as a way to cope with  emotional or physical pain. 10. Know the warning signs of problem gambling.
  116. 116. SUMMARIZING THIS CONTENT • • • • • • We defined gambling & problem gambling We looked at trends We looked at connections with other issues We saw the effects on the brain We looked at how to address problem  gambling
  117. 117. Under $100 $100‐$1,000 $1,000-$2,500 More than $2,500
  118. 118. Problem gambling treatment  is ‘free’ in Oregon for  gamblers AND loved ones.
  119. 119. The average problem gambler in Oregon gambling treatment owes $4,000 in gambling-related debts.
  120. 120. The average problem gambler in  Oregon gambling treatment owes  $30,000 in  gambling‐related debts.
  121. 121. preventionlane.org facebook.com/ preventionlane twitter.com/ preventionlane
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