We don’t think of these
things as gambling.
Therefore, we don’t
think our young
people are gambling.
__________ something of value
in the ______________________
something of greater value.
hopes of obtaining
Source: American Psychiatric Association - DSM-5 (2013).
• Circle “yes” for the activities which you believe are gambling.
• Now, put an “S” next to the activities that are mostly skill-based,
and an “L” next to the activities that seem mostly luck-based
GAMBLING OR NOT?
Anything of value the sponsor awards in a promotion.
(Example: real money or a virtual reward to help
advancing in a game.)
A process beyond the participant's direct control
determines the outcome. (Example: an instant-win
game at a fast food restaurant.)
Requires money or significant effort.
(Example: inviting Facebook friends
in order to gain new “lives.”)
May 2, 2018: https://www.nytimes.com/2018/05/02/style/fortnite.html
A NEW EXPLOSION OF SPORTS.
Etc… Etc…And new games keep coming…
GAMERS ARE THE NEW STARS
GAMBLING ON THE GAMES
ESPORTS BETTING EXPECTED TO
SURPASS $6 BILLION IN 2018
GAMBLING IN ESPORTS.
1. Betting on
Image source: csgostash.com
2017 Overwatch World Cup
Image source: pcgamer.com
SKINS. Entertainment. Street Cred. Possible $.
Image Source: https://csgostash.com/
Additional Recommended Video: “Skin in the Game: Counter-Strike has spawned a wild
multibillion-dollar world of online casino gambling; it's barely regulated and open to any kid who
wants in.” ESPN.com, 1/20/17
SO MANY CONNECTIONS…
• Younger bettors avoid human connections
• Recommendation for in-play betting suggests
using TV timeouts to offer a two minute
window for players to place bets.
• Sports betting make up 15% of all global
gambling but accounts for 50% online
gambling and 68% mobile gambling.
Source: Information from 2018 Global Gaming Expo (October 2018).
Thanks to Erin Jones, University of Oregon Family & Human Services student intern, for this research!
NOT ALL GAMBLING IS PROBLEM
GAMBLING. IT’S A CONTINUUM.
Recreational Problem Pathological
Sources: Moore (2016); Volberg, Hedberg, & Moore (2008); Shaffer & Hall (2001)
Between 2-3% adults 18+ problem gamblers (2.6%)
Teens (13-17 y.o.): 6% at risk or problem gamblers 2
College age (18-24): 5.6% 3
CORTEX is the LAST
PART to develop.
Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC
Gambling & Dopamine
Dopamine not released when expecting a loss.
Flooded with dopamine when expecting a win!
It’s not about the money – it’s about the action of the game and the hope of
Role in Impulse
Serotonin -- risk taking
Gambling - β-endorphin
PGs - NE levels
PGs - dopamine response
Potential Neurotransmitter Roles
in Disordered Gambling
Dopamine: most studied neurotransmitter in problem gambling
Sources: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):159
Image source: Anheuser-Busch
• Lucky #’s
• Favorite shirt
• “My” machine
to affect the outcome.
• Example (win): “Yeah buddy! I was just waiting on my
card. I know this game inside and out.”
• Example (loss): “I would’ve won if that idiot didn’t get
lucky and draw an ace.”
Attributing wins to one’s
special skill or luck, while
losses are blamed on
Image source: Anheuser-Busch
Forgetting about losses, only
Failure to see each event as
• Trying to see patterns in coin flips.
• “This slot machine is DUE to hit!”
(Hodgins et al. 2010; Kraus et al. 2003; Najavits et al. 2010; Petry and Steinberg
2005; Taber et al. 1987)
Exposure to early childhood
trauma has consistently been associated
with disordered gambling.
GAMBLING & ACEs
Associated w/ ADHD, personality disorders
Poole, J.C., Kim, H.S., Dobson, K.S., & Hodgins, D.C.(2017, March). Adverse childhood experiences and disordered
gambling: Assessing the mediating role of emotion dysregulation. Journal of Gambling Studies, DOI
have had a
episode of care
Source: Oregon Gambling Treatment Programs Evaluation Update,
MENTAL HEALTH CONNECTIONS
• Depression/mood disorders1
– Depression – in one study, 76% of PGS had depression
– Bipolar disorder – correlations with BPD & PG
• PTSD (studies of military veterans)
– PTSD among problem gamblers estimated between 12.5 – 29% 2,3
• ADHD4 20-25% of problem gamblers
• Alcohol & other substance abuse disorders
Sources 1. Ledgerwood & Petry (2006). 2. Kausch et al. (2006). 3. Biddle et al. (2005). 4. Waluk, Youssef & Dowling (2015)
The “Addiction” Connection
• Loss of control
• Depression/mood swings
• Use as an escape
• Similar “highs”
• Self-help groups
• Family involvement
• Use of rituals
Defining “use” (gambling)
Behavior not attributable to chemical
No biological test
More intense sense of shame and guilt
Fantasies of success /quitting is giving up
Easier to hide
Some Key Risk Factors
early in life
Friends / family
Adolescent Behavior &
• Preference: excitement
and effort activities
• Prefer novelty
• Poor planning & judgment
• Minimal consideration of
• More risky, impulsive
Source: Grant, J (2008, October). The Adolescent Brain & Impulsive Behaviors. Healthy Brain Development: Key Impacts &
• Rate of problem gambling lower (1.2%) 1
• BUT living close to gambling facility risk
– six times more likely to be problem gamblers
• risk factors 2
• Gambling = most frequently
identified social activity 2
• Challenges in problem acceptance
Sources: 1. Moore (2001, ibid). 2. McNeilly & Burke (2000). Late life gambling: The attitudes and behaviors of older
adults. Journal of Gambling Studies, 16, 393-415.
People of Color
• Higher proportion of
• Spend 2.5x more on
gambling in a typical
Source: Moore, Jadlos, & Carlson, 2000
• One in three offenders meet criteria for
– Highest rate in any population
• Gambling common in prison culture
• Resources limited to investigate crime &
Sources: 1. Williams, Roysten & Hagen. (2005). Gambling and Problem Gambling Within Forensic Populations, A Review
of the Literature 2. Myers, H. (2006). Organized crime in Oregon.
Military & Veterans
• All four branches operate slot
• Service members at higher risk
– Male, younger, racial/ethnic minorities
– Marine corps highest rate of PG
Source: Department of Defense (2002). Survey of Health Related Behaviors Among Military Personnel Washington, DC:
Author. Report information available at http://www.tricare.mil/main/news/dodsurvey.htm
Typical Issues: (problem gamblers in Oregon treatment)
are current tobacco
Have had a
episode of care
Source: Oregon Gambling Treatment Programs Evaluation Update, 2016
Barnes et al.,1999; Hayatbakhsh et al., 2006; Johansson et
al., 2009; King & Delfabbro, 2016; Raylu & Oei, 2002;
Scholes-Balog et al., 2014; Shead et al., 2010; Volberg,
2008; Winters et al., 2002
- Family conflict
- Family history antisocial
- Parental gambling
- Academic failure &
poor school performance
- Low school commitment
- Early initiation
- Early big wins
- Interaction w/
- ATOD use
ADDRESS RISK FACTORS BY DOMAIN
- Exposure to gambling
- Availability & accessibility
- Media portrayal
• Prevention efforts that address RISK FACTORS
common to other problem behaviors;
• Prevention efforts that address PROTECTIVE
FACTORS (e.g., prosocial behaviors)
Examples: Alcohol & drug curricula, Life Skills programs,
parenting programs, etc.
RESEARCHERS RECOMMEND OVERALL
PREVENTION INITIATIVES AS MOST EFFECTIVE.
ID & referral
DSM Criteria Revisited
1. Preoccupation with
2. Increases amount of
3. Unsuccessfully tries to
4. Restless or irritable
when trying to cut
5. Gambles as an escape
6. “Chases” losses
7. Lies to others to conceal
8. Has jeopardized
9. Relies on others to bail
Gambling Disorder = Four or more of above, AND:
The gambling behavior is not better accounted for
by a Manic Episode.
Mild (4-5) / Moderate (6-7) /Severe (8-9)
Referred to provider for
Family members come in;
later bring gambler in
This is an actual helpline counselor. Everyone
who answers the phone is a Certified
Gambling Addictions Counselor (CGAC).
Treatment Options in Oregon
•Minimal intervention: GEAR
(Gambling Education and Reduction)
•Crisis respite (1)
•Residential treatment (1)
IT OFTEN TAKES
1) admit they have a problem
2) seek help, and then
3) continue in recovery
Larger version of this
chart: click here
Source: Written by Robert L. Custer, M.D; image source: Council on Compulsive Gambling of New Jersey, Inc..
Treatment is free.The Oregon legislature requires that 1% OF
LOTTERY PROFITS go to a Problem Gambling
Treatment is gender-specific
- Individual sessions - Family therapy
- Group sessions - Recreational counseling
- Didactic lectures - Audiovisual education
Suggest to explore 12-step program
THE “average” person
IN OREGON PROBLEM
Problem started at 37
Mostly gambles at video lottery terminals (in delis, bars, restaurants, taverns)
Owes $23K in gambling debt
Started gambling at 24
IT’S NOT ALL JUST
NEED HELP TOO!
Education about problem gambling as an addiction. What to
watch out for. Gaining tools for financial/legal/other issues.
Dealing with trust issues. Being allowed to vent rage and betrayal.
Healing from more “unfolding truths.”
No more secrets. No more bailouts!
Getting continued support. Renew sense of hope &
empowerment. Determining future of relationship.
Where we need your help:
SCREENING (Brief Biosocial
Gambling Screen - BBGS)
Wrapping it All Up
• The lines of gaming and gambling have blurred, and it’s
become much more popular
• This popularity doesn’t come without cost
• Gambling problems often mimic other disorders in
manifestation, consequences, & co-occurrence
• Problem gambling services are free, confidential, available
• Important to assess for issue & make your clients aware of
Lane County Public Health
Emergence Meridian Gambling