Addictive Behaviors - Problem Gambling

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Slides for "Problem Gambling: Hidden Addiction" class on 11/17/10 - Julie Hynes. University of Oregon Substance Abuse Prevention Program course on Addictive Behaviors with George Baskerville.

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  • Course Description:
    John Bradshaw defined compulsive/addictive behavior as "a pathological relationship to any mood-altering substance or experience that has life damaging consequences." 
    Think of an activity other than substance use that you or a friend either really enjoy or find yourselves doing quite a lot of.  Have you often done more of the activity or for a longer period than was intended?  Have you persistently tried to cut down or control this activity?  Have you given up important social, occupational, or recreational activities because of this activity?
    Sat, Sun, 9:00 AM - 2:20 PM
  • True or False
    Breast cancer is the leading cause of cancer deaths among women in the US.
    False – Since 1987 lung cancer has been the leading cause of cancer deaths among US women. Over 90% of all lung cancer deaths are smoking related.
    The amount of nicotine in cigarettes has been steadily increasing since 1998.
    True – data from 1998-2004 and has found that the average nicotine yield of cigarettes increased 10%. Target audiences of the cigarette brands with the highest nicotine yield (Newport, Camel, and Doral) and the greatest percent increase (Doral and Kool) are some of the most vulnerable populations (minorities and youth).
    “Additive free” and “natural” cigarettes (like American Spirits) are safer than other brands.
    False – Recent studies have found that additive-free cigarette delivered the nicotine, carbon monoxide and other toxic components of tobacco smoke in equal or greater amounts than conventional cigarettes.
    Smoking a hookah is less harmful than cigarettes because the smoke passes through water, which filters out the chemicals and other bad stuff.
    False – Passing through water in a hookah cools the smoke but does not filter out any chemicals or carcinogens. It actually forces the smoker to inhale twice as deeply causing the harmful smoke and cancer-causing agents to penetrate deeper into the lungs.
    New research shows that smoking increases weight gain.
    True - A recent study has found a few cigarettes a day may result in the body storing too much fat, not less.
  • 9,400 video poker machines in about 1880 bars & taverns—excluding casinos
  • Payments
    Mobile phone transfers
    Long distance phone time
    Third party
    Pre-paid debit cards
    eChecks
    Advertising:
    .net & .com
  • “Deal or No Deal” game show theme used for educational purposes only. For information about this presentation and its use, contact Julie Hynes, Lane County Health & Human Services | 541.682.3928 | julie.hynes@co.lane.or.us
    At the end of the session, participant will be able to:
    Understand the prevalence of problem gambling among Oregon youth
    Identify relationships between gambling and other risky behaviors
    State the effects of problem gambling on youth, family members and the community
    Identify signs of a problem gambler
    Understand how and where to refer someone for help or assessment
    Identify at least 3 resources which can be used in problem gambling prevention
    Deal or No Deal? Play here!
    First Deal or No Deal question: What activity has correlations with drinking, drugs, sexual activity, and violent behavior, yet little or no attention is paid to it in health courses? Would you believe it’s youth gambling? Data from Oregon Healthy Teens surveys show that gambling and other risky behaviors often go hand-in-hand, yet many parents and educators unsuspectingly promote poker and other gambling-related games as harmless recreational activities. This session will provide useful information on an increasingly popular activity that is far from risk free and will address what can be done to minimize harm from gambling.
    We will have a fun, interactive multimedia game based upon the “Deal or No Deal” game show. Easy rules! Workshop participants will receive free DVDs and facilitator guides of Oregon’s new award-winning youth problem gambling prevention video.
  • Pathological gambling is characterized by a number of phenomenon, including:
    A preoccupation with gambling
    “Magical” thinking - control the uncontrollable
    Total loss of control
    Chasing losses
    Lying and cheating
    Illegal acts
    Family bailouts
    Family disruption
    Basically, there is a continuation of the behavior despite the adverse consequences
    Gambling is no longer a form of recreation - it evolves - into the center of the individual’s life.
    Flip the coin
  • 1.1 million youth 12-17 exhibit pathological gambling behavior (National Gambling Impact Study Commission, 1999)
    5 million youth have serious gambling related problems (Jacobs, 2000)
    A problem not limited to the US & Canada but England (Fisher, Griffiths), Australia (Moore & Oshutuka), New Zealand (PGFNZ) & Spain (Becona)
  • DiClemente, 2003: Addiction & Change:
    Self-regulated engagement: Balanced view of pros and cons and acknowledgement of the potential for negative consequences
    Action stage abuse & dependence: decisions focus on the positive end of the behavior; support repeated engagement
    Normalize & minimize problems associated with it
    Relationships, beliefs, attitudes, social systems are modified to support repeated engagement
    Quantity and frequency
    Own definition or pattern of what they consider “out of control” (gambling only on weekends, certain types of gambling, etc.)
  • http://braininstitute.vanderbilt.edu/Vanderbilt_March07_PotenzaLecture.ppt
  • Other impulse control disorders:
    Kleptomania
    Compulsive sexual behavior
    Compulsive buying
    Pyromania
    Compulsive Internet use
    Trichotillomania
  • Other impulse control disorders:
    Kleptomania
    Compulsive sexual behavior
    Compulsive buying
    Pyromania
    Compulsive Internet use
    Trichotillomania
  • Those entering treatment in Oregon had an estimated combined gambling-related debt of more than $44 million.
    Behavioral, psychological, physical
    A correlation between gambling and all forms of substance abuse exists.
    Gamblers are more likely to…
    Lose their jobs, be demoted
    Fall deeply into debt and file for bankruptcy
    Lose their homes and personal property
    Accumulate legal fees due to divorce, criminal activities
    Run up medical, mental health bills
    Well-demonstrated relationship of problem gambling with other risky behaviors
    Excessive alcohol use & binge drinking
    Regular tobacco use
    Illicit drug use
    Overeating/binge eating
    Source: Engwall & Steinberg, 2003; Ladouceur, Dube, &^ Bujold, 1994; Lesieur, et al., 1991
  • 15 months – 4x as fast as horse/dog betting
  • Those entering treatment in Oregon had an estimated combined gambling-related debt of more than $44 million.
    Behavioral, psychological, physical
    A correlation between gambling and all forms of substance abuse exists.
    Gamblers are more likely to…
    Lose their jobs, be demoted
    Fall deeply into debt and file for bankruptcy
    Lose their homes and personal property
    Accumulate legal fees due to divorce, criminal activities
    Run up medical, mental health bills
    Well-demonstrated relationship of problem gambling with other risky behaviors
    Excessive alcohol use & binge drinking
    Regular tobacco use
    Illicit drug use
    Overeating/binge eating
    Source: Engwall & Steinberg, 2003; Ladouceur, Dube, &^ Bujold, 1994; Lesieur, et al., 1991
  • In a study of 111 veterans entering a problem gambling treatment program, 64 percent reported a history of emotional trauma; 30.5 percent, physical trauma; and 24.3 percent, sexual trauma. Most trauma had occurred in childhood (Kausch et al., 2006).
    www.responsiblegambling.org/en/research/PTSD_PG_proposal.pdf
  • Chance gives the illusion of Control
    Failure to see the roll of the dice or the spin of the wheel as independent events
    Rely on past events to predict future of random events
    Thoughts of…
    If I do this, then this will happen
    This has already happened-- so this must now happen
    That can’t happen again
    Interpretive bias Relating my winnings to my skill. and ability makes me continue gambling’
    Cognitive approaches to gambling: http://www.cpa-apc.org/Publications/Archives/CJP/2003/february/tavares2.asp
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10468110&dopt=Abstract
    Toneatto 1999
    These include the magnification of gambling skills, minimization of other gambler's skills, superstitious beliefs (including talismanic, behavioral, and cognitive superstitions), interpretive biases (including internal attributions, external attributions, gambler's fallacy, chasing, anthropomorphism, reframed losses, hindsight bias), temporal telescoping, selective memory, predictive skill, illusion of control over luck (including luck as an uncontrollable variable, luck as a controllable variable, luck as a trait variable, luck as a contagion), and illusory correlation. In addition, gambling-relevant beliefs about the self are also discussed, including entitlement, omnipotence, cognitive reasoning, and magical thinking.
    _____________
    Social psychology perspective why gamblers are persistent “why they keep gambling against all odds”
    Illusion of control -- unrealistic confidence that we as humans can influence random events --
    Study showed that people believed their lottery ticket was worth more of they personally selected the numbers rather than randomly distributed.
    Personal Choice- People believed they have a greater chance of winning a totally random game when they are given a chance to practice with the apparatus.
    Early wins- People who correctly predict heads or tails early in a sequence of coin toss in believe more strongly in their control than those who do not.
    Familiarity - People who are faniliar with a situation believe more strongly in their sense of control than people who are less familiar with it, even though chance determines the outcome.
    Types of Competitor People wager more against a seemingly incompetent bettor than a seemingly competent on even though once again the outcome is totally determined by chance.
    Practice- People believe they have a greater chance of winning a totally random game when they are given a chance to practice with the apparatus.
    Our tendency to interpret outcome in a self-serving way leads to our not using the outcome data effectively. We view success as related to our ability but failure as external. Once again this contributes to excessive confidence in our ability to succeed at a gambling.
    The way our minds work to organized cause and effect relationships leads us to believe random events are actually related. Bolstered by this belief we again assume an unwarranted confidence in our ability to predict and control future outcomes.
    Ex: Coin toss: Imagine a fair coin toss that has turned up tend heads in a row, many people predict that the chance of a tail coming up next is significantly higher than 50% even though probability states each outcome is totally dependent on the previous one.
  • Loss of control - Repeated attempts to stop/cut back fail
    Denial - Not always a conscious act
    Progressive - between first-time use and addiction
    Chasing - throwing good money after bad
    Blackouts - not too common, but called “going on tilt”
    Escape - think valium
    Use of rituals - ever seen a serious bingo player?
    Similar highs - speaking physiologically
    Hidden - quite easy to hide from friends and family
    Overdose - can’t do it in the conventional sense
    Financial - Average debt called into the OR hotline is 20 - 40 thousand dollars
    Work - can function at work, usually can gamble in short bursts
    Tests - no UA for gambling
    Resources - more than 13,000 in U.S. providing substance abuse tx…
    Perception - where alcoholism was about 40 years ago. Just stop!
    Gambling questions added to a student survey in of Connecticut St. Univ. students in 2000 (n=1,348)
    Problem & pathological gamblers compared with social gamblers had significantly:
    Greater tobacco, alcohol, and marijuana use
    Greater binge drinking
    Greater number of negative outcomes from drug and alcohol use
    Greater binge eating and efforts at weight control
  • Source: Grant, J. (2006, October.) Neurobiology and pharmacological treatment of pathological gambling. Presentation at Oregon Problem Gambling Services training, Bend, OR.
    Dopamine release associated with rewards and reinforcing
    Dopamine release - maximal when reward is most uncertain, suggesting it plays a central role in guiding behavior during risk-taking situations.
    Norephinephrine (NE) - an important component in the mediation of arousal, attention and sensation-seeking in PG
    PG had higher higher urine levels of NE.
    Opioid system:
    The endogenous opioid system influences the experiencing of pleasure.
    Gambling or related behaviors have been associated with elevated blood levels of the endogenous opioid β-endorphin.
  • http://braininstitute.vanderbilt.edu/Vanderbilt_March07_PotenzaLecture.ppt
  • http://www.youtube.com/watch?v=7A4Qxx7j63Y
    Recent studies have found that when we anticipate financial gains, an area of our brain known as the ventral striatum becomes activated and flooded with dopamine
    Release of dopamine also occurs during naturally rewarding activities such as eating, sex, physical activity -- & is a key factor behind our desire to repeat these activities
    To maintain even a normal level of dopamine in their brains, they must gamble with increasing frequency – and often for greater and greater stakes
    The impulse control in their brain is not functioning properly; drug addicts show a similar brain pattern – and a similar need to keep feeding their addiction
    studies have found that when we anticipate financial gains - whether at the gaming tables or on the stock market - an area of our brain known as the ventral striatum becomes activated and flooded with dopamine, a brain chemical linked to pleasurable sensations. The release of this chemical also occurs during physically rewarding activities such as eating, sex and taking drugs, and is a key factor behind our desire to repeat these activities.
    When we start to consider the possibility of losing money, however, the same brain areas become less active. In fact, most people's brains show more negative sensitivity to losses than positive sensitivity to gains - neural evidence of our tendency toward risk aversion.
    Once considered a character defect, gambling is now known to be a highly addictive disorder with neurological causes. Thanks to new advances in brain imaging, scientists are beginning to identify the neural mechanisms that go awry in the brains of pathological and problem gamblers. What they‟re learning from such research is also shedding light on how these same mechanisms determine individual risk tolerance – and influence the financial choices we all make throughout our lives. You hold your breath as the wheel spins on the roulette table. You briefly close your eyes as the croupier deals you another card at the blackjack table. You stand frozen in place as the horse you bet on lunges toward the finish line. At such moments – when you‟re anticipating the possibility of a financial reward – certain areas of your brain jump into action. The particular pattern of that activity, neuroscientists are now discovering, helps identify how risk-averse you are – not only when you‟re at the gambling table or the racetrack – but when you ponder any decision that involves some financial risk. Should you take a new job? Should you invest in a new business? Should you put your savings in potentially volatile stocks or in the “sure thing” of a bank certificate of deposit?
    Those same neural patterns may also reveal whether you‟re at risk of becoming a pathological gambler, someone so addicted to gambling that you continue the activity even while mounting losses ruin your personal finances and relationships. Recent studies have found that when we anticipate financial gains – whether at the gaming tables or on the stock market – an area of our brain known as the ventral striatum becomes activated and flooded with dopamine, a brain chemical linked to pleasurable sensations. The release of this chemical also occurs during physically rewarding activities such as eating, sex and taking drugs, and is a key factor behind our desire to repeat these activities. When we start to consider the possibility of losing money, however, the same brain areas become less active. In fact, most people‟s brains show more negative sensitivity to losses than positive sensitivity to gains – neural evidence of our tendency toward risk aversion. In one study, researchers could predict how tolerant individuals were to risk by analyzing how their brains responded to potential gains versus potential losses. Those whose brains were less turned off by the possibility of increasing their losses tended to be more eager gamblers. In pathological gamblers, neural activity in the ventral striatum remains remarkably unreactive – even during winning streaks. Their brains also show decreased activation in the ventrolateral prefrontal cortex – the brain‟s “superego” – which, when functioning normally, keeps people from acting impulsively. This finding may explain why pathological gamblers keep betting despite the havoc it inflicts on their lives. To maintain even a normal level of dopamine in their brains, they must gamble with increasing frequency – and often for greater and greater stakes. And the impulse control in their brain is not functioning properly. Drug addicts show a similar brain pattern – and a similar need to keep feeding their addiction.
    Recently, pathological gambling has been found to be a rare side effect of specific types of dopamine agonists, drugs used to treat the tremors and balance problems associated with Parkinson‟s disease. The dopamine boost from these drugs appears to overload receptors in the ventral striatum, causing an irresistible urge to gamble. The effect does not occur in everybody who takes dopamine agonists and it dissipates once the medication is discontinued. Source: http://www.sfn.
    Good introductory video on dopamine & dopamine receptors:
    http://www.youtube.com/watch?v=7A4Qxx7j63Y
  • Previously, it was thought that most brain development was complete by adolescence and that teenagers‟ brains were as fully matured as adult brains. As the result of increasingly sophisticated research and imaging abilities, we now know this is not the case. Just as teens‟ bodies are maturing and their social skills are expanding, their cognitive centers are also in flux.
    During adolescence, the brain adopts a ―use-it-or-lose-it‖ pruning system, resulting in a decreasing number of connections among brain cells even as the speed of these connections increases. Major changes are also underway in the prefrontal cortex (PFC), known as the executive planner of the brain. The PFC is responsible for weighing risks and benefits, strategic thinking, and impulse control. Throughout adolescence, the PFC is refining its wiring to become more sophisticated. Studies demonstrate that the PFC is among the last parts of the brain to fully develop, in many cases not maturing until well into the third decade of life. Unused branches are sloughed off, and other pathways are refined. As this construction phase progresses, synapses that normally go through the PFC in an adult brain are instead re-directed to the amygdala, known as the emotional center of the brain. When this happens, the response is rooted in emotion—fight, flight, freeze, freak out—rather than rationality. The amygdala can also misinterpret others‟ facial emotions, perceiving fear or nervousness as anger or hostility. All these processes can alter the ability of adolescents to harness their decision-making abilities, making them more vulnerable to risk-taking and impulsive behaviors. As a parent, when you sometimes feel your son or daughter is over-reacting or misinterpreting, you have likely met their developing brain in action. The adolescent brain is especially sensitive to the effects of dopamine, a chemical neurotransmitter that is activated by substance use, exposure to high-intensity media, and gambling, as well as food and sex. It is still not known how much of brain development is influenced by environment vs. genetics, but some evidence suggests that constructive learning experiences can positively shape teen cognitive development. As research results have emerged, some public health professionals have voiced concern that the results will be used to squelch teen independence or rights in areas such as reproductive health and health care decisions. Public health policy and science provide us with a few key responses to that concern. First, brain development, as an isolated issue, should be just one of several factors considered when designing good programs and policies. Second, it is important to recognize that successful brain development relies on exercising this organ. From a use-it-or-lose-it perspective of refining maturing brain connections, it would be most productive for caring adults to provide meaningful opportunities for adolescents to exercise brain functions that require analytical, decision-making, and valuing skills, to help teens demonstrate their real and valuable role in making good decisions and advocating for their health.
    Source: http://www.nwpublichealth.org/archives/s2007/adolescent-brain
    7
  • Gambling is everywhere
    This is the first generation to grow up with gambling as the norm and seen as harmless fun
  • 1.1 million youth 12-17 exhibit pathological gambling behavior (National Gambling Impact Study Commission, 1999)
    5 million youth have serious gambling related problems (Jacobs, 2000)
    A problem not limited to the US & Canada but England (Fisher, Griffiths), Australia (Moore & Oshutuka), New Zealand (PGFNZ) & Spain (Becona)
    Problem is rising
    Youth are gambling more
    First generation of youth exposed to ready access & ways to gamble
    Rapid movement from social to pathological gambler
    Long-term costs unknown
  • generic
  • Paid through Lottery funds
    Gambling Evaluation and Reduction Program (GEAR)
    Corrections Program
    27 outpatient treatment centers (Emergence Program in Lane County)
    3 crisis-respite programs
    1 residential treatment program
  • Behavioral, psychological, physical
    A correlation between gambling and all forms of substance abuse exists.
    Gamblers are more likely to…
    Lose their jobs, be demoted
    Fall deeply into debt and file for bankruptcy
    Lose their homes and personal property
    Accumulate legal fees due to divorce, criminal activities
    Run up medical, mental health bills
    Well-demonstrated relationship of problem gambling with other risky behaviors
    Excessive alcohol use & binge drinking
    Regular tobacco use
    Illicit drug use
    Overeating/binge eating
    Source: Engwall & Steinberg, 2003; Ladouceur, Dube, &^ Bujold, 1994; Lesieur, et al., 1991
  • Addictive Behaviors - Problem Gambling

    1. 1. Addictive Behaviors | 11.17.10Addictive Behaviors | 11.17.10 Julie HynesJulie Hynes,, MA, CPSMA, CPS Lane County Health & Human ServicesLane County Health & Human Services hiddenhidden addiction :
    2. 2. Go Ducks! Photo source: http://www.thetribonline.com
    3. 3. Overview of This Afternoon’s Class Gambling: Overview & trends Defining “problem gambling” Signs & addiction connections Addressing the issue Discussions Note: these online handouts are online for your reference -- www.preventionlane.org/george.htm
    4. 4. Oregonians voted for the Lottery Most people can gamble without harm Some people cannot gamble without harm Those who cannot gamble without harm should seek help… So… safety is our primary concern.
    5. 5. Overview & Trends
    6. 6. Oregon’s #1 tourist attraction. Until…
    7. 7. 1931 1989 Sports Action Lottery Video pokerbegan 1992 Nine tribal casinos opened 1994 - 2004 ? Lottery approved 1984 2005 Video slots started Legal Gambling in Oregon
    8. 8. Oregon’s spending on gambling 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 DHS, 2010) About $7 out of every $10 was spent on video lottery games (video poker & slots)
    9. 9. Oregon: 9 tribal casinos Each tribe has one casino Different rules in Oregon Tobacco: OK Alcohol: OK (2 casinos as of 2/10)
    10. 10. Photo source: Daniel Berman.
    11. 11. Photo: Hynes, 2/09
    12. 12. Online Gambling Fact (and Myth): Online gambling now illegal in U.S. Technically: true. Practically?
    13. 13. Groups: In-class discussion #1 1. Do a search for "online poker.“ 2. Go to one of the sites that offers online poker. Is it a ".net" or ".com"? If it's a ".net," change the end of the URL to a ".com," and vice versa if it's a ".com.“ 3. What changes between the URLs? What are the differences in content? Be prepared to discuss.
    14. 14. 1 in 146 1 in 146,000 1 in 146 million 1 in 146 billion
    15. 15. 1 in 146 Million (146,107,962) Οδδσ οφ γεττινγ στρυχκ βψ λιγητν ινγ: 1 ιν 280,000
    16. 16. Sports bets Lottery tickets Video & online Bingo & raffles
    17. 17. Video lottery & online gambling
    18. 18. 1% 40% 0.2% 3% Research shows about what percentage of adults have a gambling problem?
    19. 19. About 3% (2.7%) of Oregon adults have a gambling problem.
    20. 20. Problem Gambling
    21. 21. Teasing it out: Gambling in the context of “addiction” DiClemente (2003) defines addiction as: 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
    22. 22. PATHOLOGICAL: Persistent and recurrent maladaptive gambling behavior...results in the LOSS OF CONTROL over gambling. (DSM-IV) PROBLEM GAMBLING: Gambling behavior which causes disruptions in any major area of life: psychological, physical, social, or vocational. “PATHOLOGICAL GAMBLING” also called “compulsive gambling” or “gambling addiction” Definitions
    23. 23. Adults: 2.7% 1 Teens (13-17 y.o.): 6% at risk or problem gamblers 2 College: 5.6% (nat’l figure)3 | 3% (UO) 4 Older adults: 1.2% 5 Sources: 1. Moore (2006; ibid). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data Services (2007). 5. Moore (2001).
    24. 24. Gambling: A Continuum No Gambling Experimentation Social Problem Pathological 1.7% Source: Moore, TL. (2006). ~74,000 Oregon adults “problem gamblers” (2.7%) At-Risk 1.0%
    25. 25. Signs: Pathological Gambling 6. “Chases” losses 7. Lies to others to conceal gambling 8. Has committed illegal acts 9. Has jeopardized relationships 10. Relies on others to bail him/her out 1. Preoccupation with gambling 2. Increases amount of money gambled 3. Unsuccessfully tries to quit 4. Restless or irritable when trying to cut down/stop 5. Gambles as an escape *”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).
    26. 26. Signs: Pathological Gambling 6. “Chases” losses 7. Lies to others to conceal gambling 8. Has committed illegal acts 9. Has jeopardized relationships 10. Relies on others to bail him/her out 1. Preoccupation with gambling 2. Increases amount of money gambled 3. Unsuccessfully tries to quit 4. Restless or irritable when trying to cut down/stop 5. Gambles as an escape *”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).
    27. 27. Debt - $32,000 Crime – 38% Depression/suicide 48% seriously considered suicide 9% attempted suicide Relationship jeopardized/lost – 35% Concurrent alcohol problems – 34% Concurrent drug problems – 15% Source: Oregon DHS, 2010
    28. 28. Electronic Gambling OregonGambling Treatment 2007 Gamblers' Preferences Cards 6% Other 5% Electronic Gambling 89% Most Oregon problem gambling treatment clients say electronic gambling is their preferred method (video poker/slots, line games) Source: Oregon DHS (2010; ibid)
    29. 29. Groups: In-class discussion #2 What do you think are risk factors for problem gambling? (Example: parent who has a gambling problem) 5 minutes
    30. 30. Family history (includes sibling) gambling Early initiation of gambling Peer attitudes & involvement Community laws & norms favorable toward gambling History substance abuse History mental health issues Easy access to gambling Competitive personality Impulsive/risk-taking personality Early “big win” Source: Marotta & Hynes, 2003 Common Risk Factors
    31. 31. Groups Especially at Risk Youth Young adults Athletes Age 65+ Ethnic groups Incarcerated People with other mental health/ addictions issues Military Increasingly at risk: women
    32. 32. Mind Games & Addictions Connections
    33. 33. Mental Health/Addictions Connections Depression/mood disorders PTSD (studies of military veterans) Impulsivity ADHD Substance abuse Alcohol abuse Sources Ledgerwood & Petry (2006). Kausch et al. (2006). Biddle et al. (2005). Oregon DHS (2010). The WAGER (2002, February 12); Specker, et al., (1995); Kim & Grant (2001)
    34. 34. • 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 memory Source: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1593-604. Cognitive Distortions
    35. 35. Source: Grant, 2006. Neurobiology and Pharmacological Treatment of Pathological Gambling. Still not well understood Multiple neurotransmitter systems believed involved: Seratonin Norepinephrine (aka noradrenalin) Opioid Dopamine Important to consider in treatment
    36. 36. Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC Decisions that will likely cause us to lose money vs. win money
    37. 37. Cognitive centers in flux Amygdala active Fight or flight, emotion Decision-making altered More vulnerable to risk- taking & impulsive behaviors Brain especially sensitive to dopamine Source: Ramoski, S., Nystrom, R. (2007). “The adolescent brain is especially sensitive to the effects of dopamine, a chemical neurotransmitter that is activated by substance use, exposure to high-intensity media, and gambling, as well as food and sex. “ 1
    38. 38. Youth: A New Social Experiment
    39. 39. Photo: Hynes, 2008
    40. 40. Photo: Hynes, 2009
    41. 41. Gambling & Oregon Teens 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)
    42. 42. Addressing the Issue
    43. 43. Institute of Medicine Continuum of Care Continuum of Care
    44. 44. Prevention in Lane County inform | educate | prevent harm
    45. 45. Treatment is Free. 24 hrs: 1877-my-limit Online: 1877mylimit.org
    46. 46. Getting Results Oregon is one of the few states that appears to have averted a significant increase in problem gambling prevalence while expanding legalized gambling. Source: National Center For the Study of Gambling, 2006. Source: 2. National Center For the Study of Gambling, 2006.
    47. 47. Key Challenges Youthful subject Perception of harmlessness Stigma/shame Industry
    48. 48. Wrapping it All Up Gambling’s recent popularity has not come without cost Many population groups are susceptible to gambling problems Problem gambling has consequences similar to other addiction issues Problem gambling services are free, confidential, and effective
    49. 49. Thank You!  For More Info… Julie Hynes Lane County Health & Human Services 541.682.3928 | julie.hynes@co.lane.or.us www.preventionlane.org/gambling www.facebook.com/preventionpage
    50. 50. References American 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.htm DiClemente, 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-200 Engwall, Hunter & Steinberg (2004). Gambling and other risk behaviors on university campuses. Journal of American College Health. 52 (6); 245-255. 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. Moore, TL. (2006). Oregon gambling prevalence replication study. Salem, OR: Department of Human Services. http://gamblingaddiction.org/ Moore (2001). Older adult gambling in Oregon. Salem, OR: Department of Human Services. http://gamblingaddiction.org
    51. 51. References Northwest Survey & Data Services (2007). Lane County Health & Human Services college gambling survey. http://www.preventionlane.org/gambling/college.htm Oregon Department of Human Services, Problem Gambling Services (2010). Oregon problem gambling awareness community resource guide. Salem, OR: Author. 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-brain Rockey, 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.pdf Shaffer, 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

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