Disordered Gambling: Understanding Addictions


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April 26, 2016. Julie Hynes, PreventionLane at Lane County Public Health. Guest lecture for SAPP 407 - Understanding Addictions with George Baskerville.

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  • 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)
  • Oregon: 9 tribal casinosEach tribe has one casinoDifferent rules in OregonTobacco: OKAlcohol: OK (2 casinos as of 2/10)
  • 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
  • http://www.drbeitman.com/Papers/PSYCH0509Beitman.pdf
  • The physiological process of an addiction is demonstrated by looking at a brain of a gambler. The top image is the brain of someone gambling . . . the bottom image is of a cocaine user . . . notice how parts of the brain “light up” in anticipation of gambling, just like it does when it anticipates a drug.
  • These are data from the 2010 Lane County Student Wellness Survey, and asks students in the 6th, 8th, and 11th grades about how much they’ve done certain behaviors in the last 30 days.Gambling is the most common problem among 8th graders and alcohol use as the most prevalent problem among 11th graders. (Gambling involves betting anything of value, e.g. money, watch, etc. Types include: lottery, dice, betting on games, bingo)Alcohol is the substance most used among all ages (8%, 22%, 41%); aside from alcohol use, 8th grade substance use runs around 10% and 11th grade substance use generally in 20-30%. *Depression= ‘Did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?’
  • “Every 15 minutes” / Grim Reaper“Scared Straight”“Just say no”All may have a temporary influence, and are quite powerful…. But do not change behavior over time.
  • 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)
  • Disordered Gambling: Understanding Addictions

    1. 1. Julie Hynes, Sr. Community Health Analyst Lane County Public Health, National Council on Problem Gambling SAPP 407 | University of Oregon | 4/26/16 GAMBLING
    2. 2. THIS AFTERNOON: • History & trends • Defining gambling disorders • Addiction & mental health connections • Gambling & the brain • Addressing the issue These slides are at:
    3. 3. POTENTIAL
    4. 4. DEFINITION: ______ something of value in the _________________ something of greater value. hopes of obtaining RISKING Source: American Psychiatric Association - DSM-5 (2013).
    5. 5. A long history
    6. 6. Image sources: Oregon Lottery, Hynes
    7. 7. Image sources: Oregon Lottery, Hynes
    8. 8. 2,400 retailers in Oregon ELECTRONIC GAMBLING: “Video Poker/Slots/Line Games” Data source: Oregon LotteryPhoto: Daniel Berman.
    9. 9. $8.60 out of every $10 Lottery dollarsPhoto: Daniel Berman. ELECTRONIC GAMBLING: “Video Poker/Slots/Line Games” Data source: Oregon Lottery
    10. 10. Center photo: Daniel Berman. Our changing world. • Technology • Speed • Platform 13
    11. 11. 15
    12. 12. 16
    13. 13. Reasons for Play Theme/Genre Rewards & Reinforcements Dopamine Platforms 17
    14. 14. FANTASY SPORTS. 20
    15. 15. http://www.huffingtonpost.com/peter-v-emerson/fantasies-about- fantasy-s_b_9183680.html
    16. 16. 23
    17. 17. 24
    18. 18. 1 in 175 1 in 175,000 1 in 175 million 1 in 175 billion
    19. 19. 1 in 175 Million (175,233,510) Odds of getting struck by lightning: 1 in 280,000
    20. 20. Let’s say there is 1 RED popcorn kernel in this bag of 10,000 pieces of 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
    21. 21. So…if your lucky numbers have “almost” come up in the last 5 drawings, are your chances better, worse, or the same?
    22. 22. Sports bets Lottery tickets Video & online Bingo & raffles
    23. 23. Videolottery & onlinegambling Electronic Gambling 89% Cards 6% Other 5% Gambling Treatment Clients Gamblers' Preferences
    24. 24. 0.1% 11.2% 1.2% 2.7% Research shows about what percentage of Oregon adults have a gambling problem?
    25. 25. 2.7% of Oregon adults (1 in 37 people) have a gambling problem.
    26. 26. “Last Week Tonight with John Oliver” – 11/9/14 https://www.youtube.com/watch?v=9PK- netuhHA
    27. 27. disordered
    28. 28. PATHOLOGICAL: Persistent and recurrent maladaptive gambling behavior...results in the LOSS OF CONTROL over gambling. (DSM-IV) Definitions
    29. 29. Newlanguage
    30. 30. It’s a“Continuum” No Gambling Experimentation Recreational Problem Pathological Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data Services (2007). 5. Moore (2001). At-Risk “GAMBLING DISORDER” 2.7% of the adult population in OR (1 in every 37 Oregonians)
    31. 31. 5.6% college age (18-24) 2½ % all adults (18+) 4% teens (13-17) This is the first generation of widely available electronic gambling. We really don’t know the effects yet.
    32. 32. The new DSM-5 (May 2013) defines pathological gambling as a “behavioral addiction,” the first of its kind.
    33. 33. Can you think of any other behavioral issues that you think should be classified as addictions? Which ones? What are arguments for/against issues being called “addictions?”
    34. 34. IS IT AN “ADDICTION” 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 Definition of addiction from Diclemente, 2003
    35. 35. Source: http://www.oregon.gov/oha/amh/gambling/gear-workbook.pdf THOUGHTS, FEELINGS, ANTICIPATION, FANTASY (Gambler’s Mind, “Gambling Time/ Gambling Money”) PLANNING (Removing obstacles to gambling) GAMBLING (“Winning & Losing”) Serotonin Adrenaline Dopamine CRASH Guilt, Shame, Anger, Denial, Justification, Restless, Irritable, Depression, Panic or Numb, Suicidal Thoughts Dopamine REALITY (Self with Others) “Real Time, Real Money”
    36. 36. IS SOMEONE YOU KNOW… • Gambling to escape problems • "Chasing" losses with more gambling • Lying to family and others about the extent of gambling • Committing crimes to finance gambling • Jeopardizing or losing relationships, jobs, education because of gambling • Relying on others to bail him or her out relieve a desperate financial situation caused by gambling
    37. 37. Source: http://www.oregonlive.com/politi cs/index.ssf/2015/04/oregon_lot tery_amid_difficult.html
    38. 38. >70% are current tobacco users 24% have current alcohol problems 5% actually attempt suicide Source: Oregon Health Authority, 2014 27% experience suicidal ideation Use illicit drugs
    39. 39. AND IT’S NOT A SOLITARY PROBLEM. Each problem gambler affects an average of 6-12 others.
    40. 40. Other addiction issues Starting early in life Parental attitudes & behaviors Community laws & norms Mental health issues 51
    41. 41. AVAILABILITY.
    42. 42. Amygdala active Risk-taking & impulsivity Source: Ramoski, S., Nystrom, R. (2007). Image source: simpsons.wikia.org age…
    43. 43. Acceptability.
    44. 44. Advertising.
    45. 45. Pop-up on my kid’s game
    46. 46. 2012 Oregon Student Wellness Survey, Lane County (“ESD”) and Oregon; available at http://oregon.pridesurveys.com/esds.php?year=2012 Awareness (low).
    47. 47. ATTITUDES. Oregon parent/youth focus groups revealed: All parents’ focus group said their kids didn’t gamble All of their kids, in their own focus groups, said they did gamble Neither sees gambling as risky
    48. 48. Typical Phases of Problem Gambling Source: Custer, R. & Rosenthal, M. WINNING LOSING DESPERATION HOPELESSNESS
    49. 49. Source: Oregon Health Authority, 2015
    50. 50. PROCESS of ADDICTION.
    51. 51. Typical Phases of Problem Gambling Source: Custer, R. & Rosenthal, M. WINNING LOSING DESPERATION HOPELESSNESS
    52. 52. Winning PHASE  Early “big win”  Excitement  Feeling on top of the world  Gambling is main entertainment Image attribution: C-3PO: https://titoupaul.files.wordpress.com Yes! I am a winner.
    53. 53. Losing PHASE  Large losses  Using credit  Borrowing money  Arguing  Missing school or work I’ll get my money back in no time. My big win is just around the corner!
    54. 54. Desperation PHASE  Obsessed with next win/game  Lying  Depressed I sold my arm but still short of cash. Maybe I can ask han solo for a loan.
    55. 55. Hopelessness PHASE  Major lifeconsequences  Winning no longer a goal; staying in “action” is the goal  Lost relationships, isolation  Considering suicide  Hitting “bottom”
    56. 56. These comparisons are of course generalizations & do not by any means reflect all male & female gamblers. Comparison byStart gambling at older age than men Get addicted faster Games of choice: video slots More likely to be “escape” gamblers Start gambling younger Tend to like games of strategy & “action” (poker, sports bets) Less likely to seek help Images: disney.wikia.com
    57. 57. Watch the next few slides & think about what you are watching.
    58. 58. What Comes Next?
    59. 59. For good or bad, we are wired to see patterns in things. This can be “gambler’s fallacy” in the sense of a cognitive distortion. THIS was supposed to be “next.”
    60. 60.  18  25  21  16 At what age is the brain considered fully developed?
    61. 61. The PREFRONTAL CORTEX is the LAST PART to develop. The brain is still developing until
    62. 62. Neurotransmitter Serotonin Norepinephrine Opioids Dopamine Role in Relation to Gambling Behavior Initiation/Cessation Arousal, Excitement Pleasure, Urges Reward, Reinforcement Dopamine: most studied neurotransmitter in problem gambling  Serotonin --  risk taking Gambling -   β-endorphin PGs -   NE levels PGs -   dopamine response Neurotransmitter “PGs” = problem gamblers | Neurotransmitters are brain chemicals that transmit nerve impulses. Dopamine is known as the brain’s “reward system.”
    63. 63. 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 winning.
    64. 64. It’s about the action! THE CONNECTIONS MAKE SENSE. “ALMOST WINNING”: dopamine is activated the same as ACTUALLY winning. Problem gamblers are more likely to see their near misses as “NEAR WINS” People play LONGER when machines give them NEAR MISSES. 87
    65. 65. Sources: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):159 Anecdotal reports from problem gamblers in treatment and recovery.
    66. 66. Image source: Anheuser-Busch COGNITIVE Distortions Lucky #’s Favorite shirt “My” machine Superstition Rituals/habits that are believed to affect the outcome.
    67. 67. COGNITIVE Distortions 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.” Biased Evaluation Attributing wins to one’s special skill or luck, while losses are blamed on external circumstances.
    68. 68. Image source: Anheuser-Busch COGNITIVE Distortions Forgetting about losses, only remembering wins. Selective Memory
    69. 69. COGNITIVE Distortions Failure to see each event as independent. Examples: • Trying to see patterns in coin flips. • “This slot machine is DUE to hit!” Gambler’s Fallacy
    70. 70. Reflect: cognitive distortion Have you ever experienced a cognitive distortion? What was the experience like?
    71. 71. addressing the issue
    72. 72. It often takes yearsfor someone to 1) admit they have a problem 2) seek help, and then 3) continue in recovery
    73. 73. Check out the following chart to see some of the steps from problem gambling to recovery… Like other addictions, some people relapse and may need help several times before maintaining recovery.
    74. 74. Creating conditions in families, schools, and communities that promote the wellbeing of people Emotional, Behavioral & Physical health
    75. 75. contribute
    76. 76. Addressing the “A’s”
    77. 77. IS IT “SOCIAL” OR PROBLEM GAMBLING? Social Gambler Occasional Sticks w/ limits Hopes to win, expects to lose Can take it or leave it Problem Gambler Frequent, preoccupied Plays w/needed $, borrows Hopes & expects to WIN Primary source of “fun”
    78. 78. Intervention Helpline emergence 24/7: 1.877.MY.LIMIT Referred to provider for assessment Family members come in; later bring gambler in
    79. 79. Diagnosis (revisited) 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 6. “Chases” losses 7. Lies to others to conceal gambling 8. Has jeopardized relationships 9. Relies on others to bail him/her out Gambling Disorder = Four or more of above, AND: The gambling behavior is not better accounted for by a Manic Episode.
    80. 80. TREATMENT IS FREE. 24 hrs: 1877-my-limit Online: 1877mylimit.org
    81. 81. Minimal intervention: GEAR (Gambling Education and Reduction) Outpatient treatment Crisis respite Residential treatment TREATMENT OPTIONS IN OREGON
    82. 82. Source: Oregonian,2/16/16: http://www.oregonlive.com/portland/index.ssf/2016/ ttery_participation_rises.html
    83. 83. EMERGENCE GAMBLING TREATMENT PROGRAM Treatment free for gamblers and loved ones - >200 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 as additional help
    84. 84. MANAGING TRIGGERS. Lots of things can be triggers, but these are some key triggers. People at risk should especially avoid gambling when: H A L T ungry ngry onely ired
    85. 85. OTHER TRIGGERS
    86. 86. Even just driving down the street can be a trigger. https://www.flickr.com/photos/drbethsnow/5 995618252/in/photostream/
    87. 87. ON THE RIGHT PATH
    88. 88. SUMMARIZING today: • We defined gambling and looked at new trends • We defined when gaming/gambling becomes a problem • We saw the effects on the brain through cognitive distortions & dopamine • We looked at ways were are addressing problem gambling
    89. 89. Last chance!
    90. 90. Under $100 $100-$1,000 $1,000-$2,500 More than $2,500
    91. 91. Problem gambling treatment is ‘free’ in Oregon for gamblers AND loved ones.
    92. 92. The average problem gambler in Oregon gambling treatment owes $4,000 in gambling-related debts.
    93. 93. The average problem gambler in Oregon gambling treatment owes $30,000 in gambling-related debts.
    94. 94. preventionlane.org facebook.com/ preventionlane twitter.com/ preventionlane