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SAPP 408 | Problem Gambling | University of Oregon | Winter 2013
 

SAPP 408 | Problem Gambling | University of Oregon | Winter 2013

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Instructor: Julie Hynes, MA, CPS

Instructor: Julie Hynes, MA, CPS
Slides from in-class portion, 1/24/13

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  • Dice have symbols and not numbers because the practice is so old it precedes writing!Gambling Fruit machines originally didn’t output money. They output prizes because gambling was illegal.
  • 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)
  • http://www.oregonlive.com/politics/index.ssf/2011/08/oregon_lottery_posts_an_increa.html
  • 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."
  • Superstition, rabbits feet, the number 13, black catsMost forms of luck, gambling, playing the lottery, slot machine feverThe evil eye, hexes, most black magic
  • Superstition, rabbits feet, the number 13, black catsMost forms of luck, gambling, playing the lottery, slot machine feverThe evil eye, hexes, most black magic
  • Superstition, rabbits feet, the number 13, black catsMost forms of luck, gambling, playing the lottery, slot machine feverThe evil eye, hexes, most black magic
  • Superstition, rabbits feet, the number 13, black catsMost forms of luck, gambling, playing the lottery, slot machine feverThe evil eye, hexes, most black magic
  • 2012 SWS
  • This is the first in a series of slides which graphically illustrates why youth gambling needs to be given more attention, and why it should be included in prevention efforts aimed at other risk behaviors. Youth who gamble have much higher rates of alcohol use than those who do not gamble. These correlations have held consistent over the past several years of data collection, regardless of the particular survey used, and are also consistent with data on the national level.
  • Again, youth who gamble had much higher rates of binge drinking in the past 30 days than youth who did not gamble. We know there is not a direct cause-and-effect relationship here (ie gambling does not cause binge drinking, nor vice versa), but there is a very strong correlation. So if we want to address binge drinking and we ignore gambling, we are missing the boat on really helping kids.
  • Here we see the same pattern with youth gambling and smoking…..
  • And a similar pattern with youth gambling and marijuana use….
  • And a similar pattern with youth gambling and skipping school…
  • Youth who reported gambling more than they wanted to (a possible sign of a gambling problem) also reported higher rates of having attempted suicide in the past year than students who did not bet more than they wanted to.
  • Clearly, then, youth gambling must be addressed in the context of how it exists in the lives of youth—one of several possible risky behaviors they may try, which can lead to serious problems. The difference is that, in real life, youth gambling is the one that is routinely left off of this diagram. We need to change that for the sake of our kids, who are the first generation to grow up with gambling being the norm, being easily accessible and available, being shown as glamorous and not being discussed enough by parents and other authority figures.
  • 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 casehttp://www.problemgamblingprevention.org/docs/2011-Oregon-Problem-Gambling-Data-Book-Data-Brief.pdfUnless otherwise noted this data comes from the 2011 Gambling Programs Evaluation Update (T. Moore)
  • We need to share our data and show parents that they need to talk about this issue with their kids. We have many resources available to help them with that, as well as resources to help someone who has a gambling problem: calling 1-877-mylimit or going to 1877mylimit.org is the first step
  • “Every 15 minutes” / Grim Reaper“Scared Straight”“Just say no”All may have a temporary influence, and are quite powerful…. But are not shown to change behavior over time.
  • http://preventionlane.org/best-practices.htm

SAPP 408 | Problem Gambling | University of Oregon | Winter 2013 SAPP 408 | Problem Gambling | University of Oregon | Winter 2013 Presentation Transcript

  • GAMBLING SAPP 408 | University of Oregon Winter 2013 | Julie Hynes
  • Outline: Our Time in Class History & trends Defining the issue Gambling & the brain Vulnerable populations: spotlight on youth Addiction & mental health connections Addressing the issue Wrapping up & assignments
  • Some of Your Wishes for thisClass (per pre-class survey) “I want to know how online gambling is illegal but yet it is so available.” “My interest is learning how to deal with overcoming a gambling addiction.” “I am interested in knowing more about how this problem begins/when do people know they are actually addicted.”
  • Learning Preferences(pre-class survey)“If I had to choose how we spent most of our time in classon 1/24, my preference in order would be: (Order: "1" isMOST preferred, "5" is LEAST preferred)”
  • Getting to Know EachOther
  • $ Opportunity
  • Gambling To risk money or something of value on the outcome of an unpredictable event.
  • Anything Can Be a Bet…Image sources: ninersnation.com, docsports.com, bovada.lvOddsshark.com, wagerminds.com
  • Legal Gambling ?in Oregon Nine tribal casinos opened 1994 - 2004 Video poker began 1992 Lottery approved1931 1984 1989 Sports Action Lottery
  • Image sources: Oregon Lottery, Hynes
  • Image sources: Oregon Lottery, Hynes
  • Oregon Lottery Revenues
  • Electronic Gambling: BigHook Oregon Gambling Treatment Gamblers Preferences Electronic Gambling 87% Cards 6% Other 5%Photo source: Daniel Berman. Source: Oregon Health Authority (2012; ibid)
  • Photo: Hynes
  • Photo: Hynes
  • Online Gambling http://abcnews.go.com/GMA/video/fbi- cracks-internet-gambling-13389539
  • The “Big 3” Screenshots,1/20/13
  • Online Gambling: Big Changes http://youtu.be/j0shB567K4MSource: ABC News
  • [game we played in class]
  • All walks of life, all over But Im telling you that if your picture of a compulsive gambler is a guy thats got a 5-day beard at 12 oclock on a Sunday night at the racetrack, that aint it. In going to Gamblers Anonymous for 10 years, there are doctors, there are lawyers, there are nurses, there are housewives, there are school teachers. This disease can affect anyone.Source: http://www.businessweek.com/ap/2012-10-02/ohio-gambling-survey-gives-pre-casino-picture
  • 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”
  • Gambling: A Continuum No Recreational At-Risk Problem Pathological Gambling Experimentation Between 2-3% adults 18+ problem gamblers Teens (13-17 y.o.): 6% at risk or problem gamblers 2 College age (18-24): 5.6% 3Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & DataServices (2007). 5. Moore (2001).
  • “Social/Recreational” orProblem Gambler? Recreational Problem Gambler Gambler Occasional Frequent, preoccupied Sticks w/ limits Plays w/needed $, borrowsHopes to win, expects to Hopes & expects to WIN loseCan take it or leave it Primary source of “fun”
  • DSM-IV:“Impulse Control Disorder”
  • Signs: Pathological Gambling (DSM-IV)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).
  • DSM-V: DSM-V will define pathological gambling as a“behavioral addiction,” the first of its kind.
  • THOUGHTS, FEELINGS, ANTICIPATION, FANTASY (Gambler‟s Mind, “Gambling Time/Gambling Money”) REALITY(Self with Others,“Real Time, Real Money” ACTION PLANNING CYCLE (Removing obstacles to gambling)CRASHGuilt, Shame, Anger, Denial,Justification, Restless, Irritable, GAMBLINGDepression, Panic or Numb, (“Winning & Losing”)Suicidal Thoughts Serotonin Adrenaline DopamineSource: http://www.oregon.gov/oha/amh/gambling/gear-workbook.pdf
  •  Debt - $30,000  Crime – 25%Source: Oregon Health Authority, 2012, Register-Guard, 5/13/11
  • OF PROBLEM GAMBLERS IN OREGON TREATMENT: >70% 48% are current experience tobacco users suicidal ideation 32% 10% actually attempt have current suicide alcohol Have current problems drug problems Source: Oregon Health Authority, 2012
  • Phases of Problem GamblingWinning LosingHitting “Bottom” Desperation Crime Divorce Desperation Depression/Suicide Getting help? Source: Custer, R. (1980). “Custer Three Phase Model.”
  • Causes? (Risk Factors) Trauma -- stemming  Community norms/laws from abuse or neglect  Early initiation Mental health issues  Friends favorable Substance use toward gambling Parental attitudes & behavior Competitive family
  • Group Exercises &Discussions
  • At what age is thebrain consideredfully developed? 18 21 25 16
  • 25PrefrontalCortex
  • Addiction is a “DevelopmentalDisease”- National institute on Drug Abuse Prefrontal Cortex
  • Neurobiology  Still not well understood  Multiple neurotransmitter systems believed involved:  Seratonin  Norepinephrine (aka noradrenalin)  Opioid  Dopamine  Important to consider in treatmentSource: Grant, 2006. Neurobiology and Pharmacological Treatment of Pathological Gambling.
  • Potential NeurotransmitterRoles in PGNeurotransmitter Role in Impulse Control Serotonin  Serotonin -- risk taking Behavior Initiation/Cessation Norepinephrine -  NE levels PGsArousal, Excitement Opioids Gambling -  β-endorphin Pleasure, Urges Dopamine PGs -  dopamine response Reward, Reinforcement Dopamine: most studied neurotransmitter in problem gambling
  • Gambling & The “Doped” Brain Decisions that will likely cause us to lose money vs. win money Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC
  • Superstition
  • Source: Bud Light “Visitor” (superstitious)https://www.youtube.com/watch?v=CZx5HO_duec Go Niners!
  • Interpretive bias
  • Source: Bud Light “Labels Out”https://www.youtube.com/watch?v=GPOQ8pzY0kY
  • Selective memory
  • Gambler‟sfallacy
  • How would you describe whatyou see below?[several slides followed duringthe lecture regarding patternseeking behavior]
  • What Comes Next? …those are other ways ourminds trick us. We are wired to see patterns in things.
  • • 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 memorySource: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1593-604.
  • In Perspective
  • Mental Health/Addictions Connections  Depression/mood disorders  Narcissistic personality disorder  PTSD  Impulsivity  ADHD  Substance abuse  Alcohol abuseSources Ledgerwood & Petry (2006). Kausch et al. (2006). Biddle et al. (2005). Oregon Health Authority (2010). TheWAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001)
  • 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 a drug or alcohol addiction.Complete survey summary available at: http://preventionlane.org/gambling/collegesurvey.htm
  • Is it an “Addiction”1. Solidly established, problematic pattern of a pleasurable & reinforcing behavior2. Physiological/psychological components of behavior pattern that create dependence3. Interaction of these components in an individual which makes person resistant to changeDefinition of addiction from Diclemente (2003) Addiction And Change:How Addictions Develop And Addicted People Recover.
  • The “Addiction” Connection Similarities? Differences?  Group activity (we skipped this in class; see next slide)
  • The “Addiction” Connection Similarities? Differences? Loss of control  Defining “use” (gambling) Denial  Behavior not attributable to Depression/mood swings chemical ingestion Progressive  No biological test Tolerance Use as an escape  More intense sense of shame Preoccupation and guilt (anecdotal) Similar “highs”  Unpredictable outcome Self-help groups  Fantasies of success /quitting is Family involvement giving up hope Use of rituals  Easier to hide
  • Vulnerable Populations• Older adults • Substance abuse• College students history• Ethnic minorities • Mental health• Incarcerated persons history• Military & veterans • Youth• Women
  • 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
  • “The earlier people begingambling, the more likelythey are to experienceproblems from gambling.”- National Academy of Sciences
  • Not Your Uncle‟sGamblingResearchon: Youth gambling still under-studied & under the radar
  • •Amygdala active • Fight or flight, “The adolescent brain is emotion especially sensitive to the • Decision-making effects of dopamine. altered •More vulnerable to risk- taking & impulsive behaviorsSource: Ramoski, S., Nystrom, R. (2007).
  • 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).
  • Lane County 2012 Student Wellness Survey (SWS) 2012 Gambling, Substance Use and Mental Health among Oregon Youth 50% 40% 6th 8thPercentage 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)
  • Used alcohol in the past month 100% 90% 80% 70% 60% Percentage 50% Did not gamble 40% Gambled 30% 20% 10% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm
  • Binge drank in the last 30 days 50% 45% 40% 35% 30% Percentage 25% Did not gamble 20% Gambled 15% 10% 5% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm
  • Smoked cigarettes in the past month 50% 45% 40% 35% 30% Percentage 25% Did not gamble 20% Gambled 15% 10% 5% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm
  • Used marijuana in the past month 50% 45% 40% 35% 30% Percentage 25% Did not gamble 20% Gambled 15% 10% 5% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm
  • Skipped school one or more days in the past month 50% 45% 40% 35% Percentage 30% 25% Did not gamble 20% Gambled 15% 10% 5% 0% Grade 6 Grade 8 Grade 11Available at: www.preventionlane.org/sws.htm
  • 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 isONE COMPONENT ofProblem Behaviors sexual behavior delinquency Problem Behaviors depression gambling substance use
  • …yet it‟s not always communicatedat home or school. 2012 Oregon Student Wellness Survey, Lane County (“Esd”) and Oregon; available at http://oregon.pridesurveys.com/esds.php?year=2011
  • Identification & Treatment
  • Online: click hereSource: Written by Robert L. Custer, M.D; retrieved from Council on Compulsive Gambling of New Jersey, Inc..
  • 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
  • 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
  • Assessment Tools “Valid and Reliable”  DSM-IV 10  South Oaks Gambling Screen (SOGS)  SOGS-RA (Revised for Adolescents) Frequently Used  Gamblers Anonymous 20 Questions (GA- 20)
  • DSM-IV Criteria Revisited1. Preoccupation with 6. “Chases” losses gambling 7. Lies to others to2. Increases amount of conceal gambling money gambled 8. Has committed illegal3. Unsuccessfully tries to quit acts4. Restless or irritable 9. Has jeopardized when trying to cut relationships down/stop 10. Relies on others to5. Gambles as an escape bail him/her out Pathological Gambling = Five or more of above, AND: The gambling behavior is not better accounted for by a Manic Episode.
  • Treatment is Free. 24 hrs: 1877-my-limit Online: 1877mylimit.org
  • Treatment Options in Oregon• Minimal intervention: GEAR (Gambling Education and Reduction)• Outpatient treatment (44)• Crisis respite (2)• Residential treatment (1)
  • 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
  • Other Facts onGambling Treatment in Oregon• 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
  • 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.
  • Disrupting the Action Cycle Barriers to Money Treatment Support Systems Accountability H.A.L.T.S.Slide credit: Janese Olalde, MEd, CGAC, CADC
  • 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
  • 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
  • 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
  • Comparison of “Action” and“Escape” Pathological Gamblers Action Escape Excitement, competition Relief, escape from stress “Skilled” forms of gambling “Luck” forms of gambling (sports/poker, etc) (lottery, slots, bingo) Early onset of gambling Later onset of gambling More likely to present More likely to present narcissistic or antisocial traits depressive/dysthymic traitsSource: Center for Substance Abuse Treatment, 2005.
  • Promotion & Prevention
  • Creating conditions in families, schools, andcommunities that promote thewellbeing of people –Emotional and behavioral health –Physical health
  • Targeting Parental AttitudesParental attitudesOregon 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
  • 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
  • Risk Factors • Single-parent household • Started gambling before • Gambling on 8th grade (early cards/sports initiation) • Being male, older teen • Parents who gamble-- • Lower household income youth twice as likely to be at-risk gamblers & • Competitive four times as likely to • Having lost more than be problem gamblers $50 in a single monthSource: Volberg, et al (2008; bid).
  • Prevention: Statewide & Local Efforts Partnership with Department of Education Curriculum integration in schools Youth video Oregon youth prevalence study Community Resource Guide* Middle School Poster Contest Partnering with addictions prevention providers/groups Policy & coalition work Resource guide can be downloaded at:
  • • Crashed cars• “Scared straight”• Boot camp• One-time activities
  • [follow-up link: best practiceshttp://preventionlane.org/best-practices.h
  • FocusOur efforts havea focus on:• Public awareness• Policy
  • Problem GamblingAdvisory Committee • Meets monthly in Eugene • Works on policy & awareness issues • Comprised of professionals & community members
  • Various Methods
  • 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.
  • Key Challenges in Prevention• Youthful subject• Perception of harmlessness• Stigma/shame• Industry
  • Under $100 $1,000-$2,500$100-$1,000 More than $2,500
  • Problem gamblingtreatment is ‘free’ inOregon for gamblersAND loved ones.
  • Summarizing this evening• Defining gambling & problem gambling• Trends• Addictions connections• The brain• Addressing problem gambling
  • Some of Your Wishes for thisClass (per pre-class survey) “I want to know how online gambling is illegal but yet it is so available.” “My interest is learning how to deal with overcoming a gambling addiction.” “I am interested in knowing more about how this problem begins/when do people know they are actually addicted.”
  • Assignments: Blackboard
  • Contact info: Julie Hynes, MA, CPS Course questions: hynes@uoregon.edu Other contact info: Lane County Public Health Prevention Program 541.682.3928 | julie.hynes@co.lane.or.us preventionlane.org problemgamblingprevention.org
  • Additional ReferencesAmerican 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.htmDiClemente, C. (2003). Addiction and change: How addictions develop and addicted people recover. New York: Guilford Press.ECONorthwest (2009). The contributions of Indian gaming to Oregon’s economy. http://www.econw.com/reports/2009_ECONorthwest_Contributions-Indian-Gaming-Oregon-Economy- 2007.pdfEngwall, Hunter & Steinberg (2004). Gambling and other risk behaviors on university campuses. Journal of American College Health. 52 (6); 245-255.Freimuth, M. (2008). Addicted? Recognizing Destructive Behavior Before Its Too Late . Maryland: Rowman & Littlefield Publishers.Kerber (2005). Problem and pathological gambling among college athletes. Annual of Clinical Psychiatry. 17 (4); 243-7.LaBrie, R., Shaffer, H., LaPlante, D., and Wechslet, H. (2003). Correlates of college student gambling in United States. Journal of American College Health. 52 (2); 53-62.Marotta, J. & Hynes, J. (2003, August). Problem Gambling Prevention Resource Guide for Prevention Professionals. Salem, OR. Oregon Department of Human Services. http://preventionlane.org/gambling/Docs/Problem-Gambling-Prevention-Guide-Marotta-Jeffrey-Hynes- Julie.pdfMoore , T.L. (2002.) The etiology of pathological gambling. Salem, OR: Department of Human Services. http://www.oregoncpg.com
  • Additional ReferencesMoore, TL. (2006). Oregon gambling prevalence replication study. Salem, OR: Department of Human Services. http://www.oregoncpg.comMoore (2001). Older adult gambling in Oregon. Salem, OR: Department of Human Services. http://www.oregoncpg.comNorthwest Survey & Data Services (2010). Lane County Health & Human Services college gambling survey. http://www.preventionlane.org/gambling/college.htmOregon Health Authority, Problem Gambling Services (2011). Oregon problem gambling awareness community resource guide. Salem, OR: Author.Oregon Lottery (2009). Oregon State Lottery Behavior and Attitude Tracking Study. November 2008. InfoTek Research Group, Inc.Oregon Lottery (2008). Overview through fiscal year 2009. Salem, OR: Author.Ramoski, S., Nystrom, R. (2007). The changing adolescent brain. Northwest Public Health. http://www.nwpublichealth.org/archives/s2007/adolescent-brainRockey, D.L., Beason, K.R., & Gilbert, J.D. (2002). Gambling by college athletes: An association between problem gambling and athletes. http://www.camh.net/egambling/archive/pdf/EJGI-issue7/EJGI-issue7- research-rockey.pdfShaffer, H.J., Donato, Labrie, Kidman, & LaPlante. (2005). The epidemiology of college alcohol and gambling policies. Harm Reduction Journal. 2 (1).Shaffer, H.J. & Hall, M.N. (2001). Updating and refining meta-analytic prevalence estimates of disordered gambling behavior in the United States and Canada. Canadian Journal of Public Health, 92(3), 168-172.Volberg, R.A., Hedberg, E.C., & Moore, T.L. (2008). Adolescent Gambling in Oregon. Northhampton, MA: Gemini Research. http://gamblingaddiction.org