What’s hidden inthose cards?      Inside the World of   Problem Gambling           Julie Hynes, MA, CPS           “Thinkin...
Our Evening “Out of the Box” –what it isn’t We aren’t going to talk about HOW to treat gamblers
Our Evening“Out of the Box”What it is:•   Why problem gambling    deserves our attention•   Addiction & mental    health c...
$ Opportunity
Gambling     To risk money or  something of value on    the outcome of an unpredictable event.
Anything Can Be a Bet…Image sources: sportsbet.com, bovada.comOddsshark.com, wagerminds.com
Betting on Brangelina              Image source: telegraph.co.uk              Odds: wagerminds.org
Image sources: Oregon Lottery, Hynes
Not YourUncle’sGambling
Available
It’s everywhere.
Gambling: A Continuum      No                     Recreational                   At-Risk            Problem         Pathol...
“Social/Recreational” orProblem Gambler? Recreational                   Problem  Gambler                       Gambler    ...
Definitions                               PATHOLOGICAL:                           Persistent and recurrent                ...
Signs: Pathological     Gambling (DSM-IV-TR)1.   Preoccupation with                                   6.  “Chases” losses ...
“Addiction”1.   Solidly established, problematic pattern of a     pleasurable & reinforcing behavior2. Physiological/psych...
The “Addiction” Connection     Similarities?                Differences?   Loss of control           Defining “use” (gam...
 Debt - $30,000 Crime – 25% Depression/suicide   48% seriously considered suicide   9% attempted suicide Relationshi...
Phases of Problem GamblingWinning                       LosingHitting “Bottom” Desperation Crime Divorce Depression/Su...
Causes? (Risk Factors) Trauma -- stemming       Community norms/laws  from abuse or neglect                           E...
Vulnerable Populations• Older adults          • Substance abuse• College students         history•   Ethnic minorities    ...
In Perspective
Addiction is a “DevelopmentalDisease”- National institute on Drug Abuse                                Prefrontal         ...
Potential NeurotransmitterRoles in PG                                           Role in ImpulseNeurotransmitter           ...
Gambling & The “Doped” Brain             Decisions that will likely cause us to                 lose money vs. win money  ...
 1 in 175        1 in 175 million 1 in 175,000    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 popcornkernel in this bag of 10,000 piecesof popcorn                ….you’d have a better        ...
So…if your lucky numbershave “almost” come up in thelast 5 drawings, are yourchances better, worse, or thesame?
How would you describe whatyou see below?
 Magical  Thinking Superstition
Personalization
Selective memory
Cognitive Dissonance
Mental Health/Addictions Connections    Depression/mood disorders    Narcissistic personality disorder    PTSD    Impu...
Comparison of “Action” and“Escape” Pathological Gamblers              Action                                        Escape...
Effects of Problem Gambling onChildren Prone to abuse and/or neglect Child endangerment may increase Higher levels of t...
•Amygdala active    • Fight or flight, emotion             “The adolescent brain is                                       ...
2010 Oregon Student Wellness           Survey (Lane County)                                                               ...
Youth gambling and alcohol use                      Used alcohol in the past month               100%               90%   ...
Youth gambling and binge drinking                         Binge drank in past 30 days               50%               45% ...
Youth gambling and smoking                     Smoked cigarettes in the past month               50%               45%    ...
Youth gambling and marijuana                     Used marijuana in the past month               50%               45%     ...
Youth gambling and skippingschool                     Skipped school one or more days in the past month               50% ...
Youth gambling and suicide attempts                Percent of youth who attempted suicide in the past                     ...
Youth problem gambling andsuicide attempts                Percent of youth that attempted suicide in the past             ...
Conclusion:    Teens who gamble are    smoked up, toked up,   drunk emo delinquents.
Conclusion:    Teens who gamble are    smoked up, toked up,   drunk emo delinquents.
Problem Gambling isONE COMPONENT of ProblemBehaviors                            sexual                           behavior ...
identification &treatment
University of Oregon Survey2010    A majority of students (62%) thought    problems with gambling could be    changed thro...
Intervention• Intake/Assessment• Referral to provider for  assessment• Family members in
The “Lie-Bet” Screening Tool (Johnson et al., 1988)        preventionlane.org/gambling/lie-bet.htm1. Have you ever felt th...
Assessment Tools• “Valid and Reliable”  – DSM-IV 10  – South Oaks Gambling Screen (SOGS)  – SOGS-RA (Revised for Adolescen...
DSM-IV-TR Criteria Revisited1. Preoccupation with           6. “Chases” losses   gambling                                7...
TreatmentNebraska DHHS Gamblers Assistance Program:• http://dhhs.ne.gov/behavioral_health/Doc  uments/GAP-FY12-13ProviderM...
Treatment is Effectiveand Inexpensive• $3,224: Cost per successful completer• 86%: Report no, or far reduced, gambling  So...
Thank you! For more Info…            Julie Hynes, MA, CPS            Lane County Public Health Prevention            Progr...
ReferencesAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mentaldisorders (4th ed., text re...
ReferencesMoore, TL. (2006). Oregon gambling prevalence replication study. Salem, OR:Department of Human Services. http://...
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
What's Hidden in those Cards? Inside the World of Problem Gambling
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What's Hidden in those Cards? Inside the World of Problem Gambling

  1. 1. What’s hidden inthose cards? Inside the World of Problem Gambling Julie Hynes, MA, CPS “Thinking Outside the Box” NCA 2012 Conference
  2. 2. Our Evening “Out of the Box” –what it isn’t We aren’t going to talk about HOW to treat gamblers
  3. 3. Our Evening“Out of the Box”What it is:• Why problem gambling deserves our attention• Addiction & mental health connections• ID & referral• Fun (Family Feud!)
  4. 4. $ Opportunity
  5. 5. Gambling To risk money or something of value on the outcome of an unpredictable event.
  6. 6. Anything Can Be a Bet…Image sources: sportsbet.com, bovada.comOddsshark.com, wagerminds.com
  7. 7. Betting on Brangelina Image source: telegraph.co.uk Odds: wagerminds.org
  8. 8. Image sources: Oregon Lottery, Hynes
  9. 9. Not YourUncle’sGambling
  10. 10. Available
  11. 11. It’s everywhere.
  12. 12. 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).
  13. 13. “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”
  14. 14. Definitions PATHOLOGICAL: Persistent and recurrent maladaptive gambling behavior...results in the “PATHOLOGICAL LOSS OF CONTROL over gambling. (DSM-IV)GAMBLING” also called“compulsive gambling” or“gambling addiction”
  15. 15. Signs: Pathological Gambling (DSM-IV-TR)1. Preoccupation with 6. “Chases” losses gambling 7. Lies to others to conceal2. Increases amount of money gambling gambled 8. Has committed illegal acts3. Unsuccessfully tries to 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. 16. “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
  17. 17. 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 Family involvement is giving up hope Use of rituals  Easier to hide
  18. 18.  Debt - $30,000 Crime – 25% Depression/suicide  48% seriously considered suicide  9% attempted suicide Relationship jeopardized/lost – 35% Concurrent alcohol problems – 34% Concurrent drug problems – 15%Source: Oregon Health Authority, 2011
  19. 19. Phases of Problem GamblingWinning LosingHitting “Bottom” Desperation Crime Divorce Depression/Suicide Desperation Getting help? Source: Custer, R. (1980). “Custer Three Phase Model.”
  20. 20. Causes? (Risk Factors) Trauma -- stemming  Community norms/laws from abuse or neglect  Early initiation Mental health issues  Friends favorable toward Substance use gambling Parental attitudes & behavior Competitive family
  21. 21. Vulnerable Populations• Older adults • Substance abuse• College students history• Ethnic minorities • Mental health• Incarcerated persons history• Military & veterans • Youth• Women
  22. 22. In Perspective
  23. 23. Addiction is a “DevelopmentalDisease”- National institute on Drug Abuse Prefrontal Cortex
  24. 24. Potential NeurotransmitterRoles in PG Role in ImpulseNeurotransmitter Control Serotonin  Serotonin -- risk taking Behavior Initiation/Cessation Norepinephrine PGs -  NE levels Arousal, Excitement Opioids Gambling -  β-endorphin Pleasure, Urges Dopamine PGs -  dopamine response Reward, Reinforcement Dopamine: most studied neurotransmitter in problem gambling
  25. 25. 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
  26. 26.  1 in 175  1 in 175 million 1 in 175,000  1 in 175 billion
  27. 27. 1 in 175 Million (174,233,510)Odds of getting struck by lightning: 1 in 280,000
  28. 28. Let’s say there is 1 RED popcornkernel in this bag of 10,000 piecesof 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
  29. 29. So…if your lucky numbershave “almost” come up in thelast 5 drawings, are yourchances better, worse, or thesame?
  30. 30. How would you describe whatyou see below?
  31. 31.  Magical Thinking Superstition
  32. 32. Personalization
  33. 33. Selective memory
  34. 34. Cognitive Dissonance
  35. 35. 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).The WAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001)
  36. 36. 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.
  37. 37. Effects of Problem Gambling onChildren 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
  38. 38. •Amygdala active • Fight or flight, emotion “The adolescent brain is especially sensitive to the • Decision-making effects of dopamine. altered •More vulnerable to risk- taking & impulsive behaviorsSource: Ramoski, S., Nystrom, R. (2007).
  39. 39. 2010 Oregon Student Wellness Survey (Lane County) Lane County Youth Gambled Drank Alcohol Binge Drank Alcohol Smoked MJ Smoked Cigarettes 50 44.3 45 41.0 40 Percentage 34.5 33.7 35 30 27.2 25 22.6 21.8 20 14.1 15 11.9 8.5 9.1 10 6.9 5 1.4 2.4 2.1 0 6th 8th 11th GradeData Source: Oregon Student Wellness Survey, 2010 Full report available at: http://preventionlane.org/sws.htm
  40. 40. Youth gambling and alcohol use Used alcohol in the past month 100% 90% 80% 70% 60% Percentage 50% Did not gamble Gambled 40% 30% 20% 10% 0% Grade 6 Grade 8 Grade 11
  41. 41. Youth gambling and binge drinking Binge drank in past 30 days 50% 45% 40% 35% 30% Percentage 25% Did not gamble Gambled 20% 15% 10% 5% 0% Grade 6 Grade 8 Grade 11
  42. 42. Youth gambling and smoking Smoked cigarettes in the past month 50% 45% 40% 35% 30% Percentage 25% Did not gamble Gambled 20% 15% 10% 5% 0% Grade 6 Grade 8 Grade 11
  43. 43. Youth gambling and marijuana Used marijuana in the past month 50% 45% 40% 35% 30% Percentage 25% Did not gamble Gambled 20% 15% 10% 5% 0% Grade 6 Grade 8 Grade 11
  44. 44. Youth gambling and skippingschool Skipped school one or more days in the past month 50% 45% 40% 35% 30% Percentage 25% Did not gamble Gambled 20% 15% 10% 5% 0% Grade 6 Grade 8 Grade 11
  45. 45. Youth gambling and suicide attempts Percent of youth who attempted suicide in the past year 30% 25% Percentage 20% Did not gamble 15% 11.3% 9.0% Gambled 10% 7.2% 5.0% 5% 0% Grade 8 Grade 11
  46. 46. Youth problem gambling andsuicide attempts Percent of youth that attempted suicide in the past year 30% 25% 21.0% Did not 18.6% bet/gamble Percentage 20% more than 15% wanted to 10.1% 10% 8.0% Bet/gambled 5% more than wanted to 0% Grade 8 Grade 11
  47. 47. Conclusion: Teens who gamble are smoked up, toked up, drunk emo delinquents.
  48. 48. Conclusion: Teens who gamble are smoked up, toked up, drunk emo delinquents.
  49. 49. Problem Gambling isONE COMPONENT of ProblemBehaviors sexual behavior delinquency Problem smoking Behaviors gambling drug use
  50. 50. identification &treatment
  51. 51. University of Oregon Survey2010 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.
  52. 52. Intervention• Intake/Assessment• Referral to provider for assessment• Family members in
  53. 53. The “Lie-Bet” Screening Tool (Johnson et al., 1988) preventionlane.org/gambling/lie-bet.htm1. 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
  54. 54. 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)
  55. 55. DSM-IV-TR 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.
  56. 56. TreatmentNebraska DHHS Gamblers Assistance Program:• http://dhhs.ne.gov/behavioral_health/Doc uments/GAP-FY12-13ProviderManual.pdfNebraska Council on Compulsive Gambling• www.nebraskacouncil.com
  57. 57. 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.
  58. 58. Thank you! For more Info… Julie Hynes, MA, CPS Lane County Public Health Prevention Program 541.682.3928 | julie.hynes@co.lane.or.us preventionlane.org problemgamblingprevention.org
  59. 59. ReferencesAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mentaldisorders (4th ed., text revision). Washington, DC: Author.Cross, Del Carmen Lorenzo, & Fuentes (1999). The extent and nature of gambling among collegestudent athletes. Ann Arbor, MI: University of Michigan Department of Athletics.Department of Defense (2002). Survey of health related behaviors among military personnelWashington, DC: Author. Report information availablehttp://www.tricare.mil/main/news/dodsurvey.htmDiClemente, C. (2003). Addiction and change: How addictions develop and addicted peoplerecover. 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 ClinicalPsychiatry. 17 (4); 243-7.LaBrie, R., Shaffer, H., LaPlante, D., and Wechslet, H. (2003). Correlates of college studentgambling in United States. Journal of American College Health. 52 (2); 53-62.Moore , T.L. (2002.) The etiology of pathological gambling. Salem, OR: Department of HumanServices. http://www.oregoncpg.com
  60. 60. 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 HumanServices. http://www.oregoncpg.comNorthwest Survey & Data Services (2007). Lane County Health & Human Servicescollege gambling survey. http://www.preventionlane.org/gambling/college.htmOregon Health Authority, Problem Gambling Services (2011). Oregon problemgambling 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 PublicHealth. http://www.nwpublichealth.org/archives/s2007/adolescent-brainRockey, D.L., Beason, K.R., & Gilbert, J.D. (2002). Gambling by college athletes: Anassociation 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 ofcollege alcohol and gambling policies. Harm Reduction Journal. 2 (1).Shaffer, H.J. & Hall, M.N. (2001). Updating and refining meta-analytic prevalenceestimates of disordered gambling behavior in the United States and Canada. CanadianJournal 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

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