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”
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”
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).
“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
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
Phases of Problem GamblingWinning LosingHitting “Bottom” Desperation Crime Divorce Depression/Suicide Desperation 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 toward Substance use gambling Parental attitudes & behavior Competitive family
Vulnerable Populations• Older adults • Substance abuse• College students history• Ethnic minorities • Mental health• Incarcerated persons history• Military & veterans • Youth• Women
Addiction is a “DevelopmentalDisease”- National institute on Drug Abuse Prefrontal Cortex
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
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
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 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
So…if your lucky numbershave “almost” come up in thelast 5 drawings, are yourchances better, worse, or thesame?
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)
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.
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
•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).
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
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
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
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
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
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
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
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 delinquency Problem smoking Behaviors gambling drug use
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.
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 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-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.
TreatmentNebraska DHHS Gamblers Assistance Program:• http://dhhs.ne.gov/behavioral_health/Doc uments/GAP-FY12-13ProviderManual.pdfNebraska Council on Compulsive Gambling• www.nebraskacouncil.com
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.
Thank you! For more Info… Julie Hynes, MA, CPS Lane County Public Health Prevention Program 541.682.3928 | firstname.lastname@example.org preventionlane.org problemgamblingprevention.org
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
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