Problem Gambling - SAPP 408 - University of Oregon


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Julie Hynes, MA, CPS, Instructor | University of Oregon
May 2012
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  • Dice have symbols and not numbers because the practice is so old it precedes writing!Gambling Fruit machines originally didn’t output money. They output prizes because gambling was illegal.
  • 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)
  • Harvard researcher Christine Reilly on online gambling: "The Internet is quick and easy and offers instant gratification. It leaves you very little time to think. You just act without noting the drawbacks."
  • 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
  • Superstition, rabbits feet, the number 13, black catsMost forms of luck, gambling, playing the lottery, slot machine feverThe evil eye, hexes, most black magic
  • Paid through Lottery fundsGambling Evaluation and Reduction Program (GEAR)Corrections Program27 outpatient treatment centers (Emergence Program in Lane County)3 crisis-respite programs1 residential treatment program
  • 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 case otherwise noted this data comes from the 2011 Gambling Programs Evaluation Update (T. Moore)
  • 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?’
  • This is the first in a series of slides which graphically illustrates why youth gambling needs to be given more attention, and why it should be included in prevention efforts aimed at other risk behaviors. Youth who gamble have much higher rates of alcohol use than those who do not gamble. These correlations have held consistent over the past several years of data collection, regardless of the particular survey used, and are also consistent with data on the national level.
  • Again, youth who gamble had much higher rates of binge drinking in the past 30 days than youth who did not gamble. We know there is not a direct cause-and-effect relationship here (ie gambling does not cause binge drinking, nor vice versa), but there is a very strong correlation. So if we want to address binge drinking and we ignore gambling, we are missing the boat on really helping kids.
  • Here we see the same pattern with youth gambling and smoking…..
  • And a similar pattern with youth gambling and marijuana use….
  • And a similar pattern with youth gambling and skipping school…
  • Youth who reported gambling more than they wanted to (a possible sign of a gambling problem) also reported higher rates of having attempted suicide in the past year than students who did not bet more than they wanted to.
  • Many of the risk behaviors of concern are decreasing over time, while youth gambling is significantly increasing. More attention needs to be paid to this important and emerging risk behavior, particularly when you view it in terms of the correlation between youth gambling and these other, more well known, behaviors—the next series of slides will shed some light on this.
  • Clearly, then, youth gambling must be addressed in the context of how it exists in the lives of youth—one of several possible risky behaviors they may try, which can lead to serious problems. The difference is that, in real life, youth gambling is the one that is routinely left off of this diagram. We need to change that for the sake of our kids, who are the first generation to grow up with gambling being the norm, being easily accessible and available, being shown as glamorous and not being discussed enough by parents and other authority figures.
  • We need to share our data and show parents that they need to talk about this issue with their kids. We have many resources available to help them with that, as well as resources to help someone who has a gambling problem: calling 1-877-mylimit or going to is the first step
  • “Every 15 minutes” / Grim Reaper“Scared Straight”“Just say no”All may have a temporary influence, and are quite powerful…. But are not shown to change behavior over time.
  • All kids should know about the risks of gambling and some need even more focus—this slide lists the kids who we know, from the latest research, are at the greatest risk of developing gambling problems.
  • Problem Gambling - SAPP 408 - University of Oregon

    1. 1. problem gambling Julie Hynes, MA, CPSSubstance Abuse Prevention Program University of Oregon SAPP 408 - May 2012
    2. 2. Ground Rules &Expectations From your instructor From each other Your expectations for the course
    3. 3. Outline:Day 1 History & trends Defining the issue Gambling & the brain Addiction connections Treatment: Michele Tantriella-Modell Wrapping up Day 1 – “assignment”
    4. 4. Outline:Day 2  Family dynamics & multicultural issues: Janese Olalde  Recovering problem gambler: Dave  Lunch  Prevention  Wrapping up
    5. 5. $ Opportunity
    6. 6. “Young EntrepreneurOpens CorvallisPlayers Den”Smith said that the most commonmisconception about poker is that itis gambling. - Hannah Mahoney, The Daily Barometer, 3/4/11 Photo: Curtis Barnard. Source:
    7. 7. Gambling To risk money or something of value on the outcome of an event.
    8. 8. Anything Can Be a Bet… Image sources:,
    9. 9. Betting on Brangelina
    10. 10. Legal Gambling in ?Oregon Nine tribal casinos opened 1994 - 2004 Video poker began 1992 Lottery approved1931 1984 1989 Sports Action Lottery
    11. 11. Image sources: Oregon Lottery, Hynes
    12. 12. Image sources: Oregon Lottery, Hynes
    13. 13. Oregon Lottery Revenues
    14. 14. Electronic Gambling: Big Hook Oregon Gambling Treatment Gamblers Preferences Electronic Gambling 87% Cards 6% Other 5%Photo source: Daniel Berman. Source: Oregon Health Authority (2012; ibid)
    15. 15. Photo: Hynes
    16. 16. Photo: Hynes
    17. 17. Online Gambling: Big Changes ABC News
    18. 18. Groups: In-class discussion1. Do a search for "online poker.“2. Go to one of the sites that offers online poker. Is it a ".net" or ".com"? If its a ".net," change the end of the URL to a ".com," and vice versa if its a ".com.”  EXAMPLE: If you’re at, go to fulltiltpoker.net3. What changes between the URLs? What are the differences in content? Be prepared to discuss.
    19. 19.,,
    20. 20. Gambling: A Continuum No Social At-Risk Problem Pathological Gambling Experimentation ~74,000 Oregon adults “problem gamblers” (2.7%) 1 Teens (13-17 y.o.): 6% at risk or problem gamblers 2 College: 5.6% (nat’l figure)3 | 3% (UO) 4Sources: 1. Moore (2006; ibid). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey &Data Services (2007). 5. Moore (2001).
    21. 21. Identification: “Social” orProblem Gambler? Social 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”
    22. 22. Teasing it out: Gambling in thecontext of “addiction”DiClemente (2003) defines addiction as: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 change
    23. 23. Definitions PATHOLOGICAL: Persistent and recurrent maladaptive gambling “PATHOLOGICAL behavior...results in theGAMBLING” also called LOSS OF CONTROL over gambling. (DSM-IV)“compulsive gambling” or“gambling addiction”
    24. 24. Signs: Pathological Gambling1. 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).
    25. 25.  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
    26. 26. Phases of Problem GamblingWinning LosingHitting “Bottom” Desperation Crime Divorce Depression/Suicide Desperation Getting help? Source: Custer, R. (1980). “Custer Three Phase Model.”
    27. 27. 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
    28. 28. 1 in 175 1 in 175 million1 in 175,000 1 in 175 billion
    29. 29. 1 in 175 Million (174,233,510)Odds of getting struck by lightning: 1 in 280,000
    30. 30. Let’s say there is 1 REDpopcorn 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
    31. 31. Research shows about what percentage of adults have a gambling problem?1% 0.2%40% 3%
    32. 32. About 3%(2.7%) of Oregon adults have a gambling problem.
    33. 33. Sports betsLottery ticketsVideo & onlineBingo & raffles
    34. 34. Gambling Treatment Clients Gamblers Preferences Electronic Gambling 89% Cards 6% Other 5%
    35. 35. At what age is thebrain consideredfully developed? 18 21 25 65
    36. 36. In Perspective
    37. 37. Addiction is a “DevelopmentalDisease”- National institute on Drug Abuse Prefrontal Cortex
    38. 38. Neurobiology  Still not well understood  Multiple neurotransmitter systems believed involved:  Seratonin  Norepinephrine (aka noradrenalin)  Opioid  Dopamine  Important to consider in treatmentSource: Grant, 2006. Neurobiology and Pharmacological Treatment of Pathological Gambling.
    39. 39. 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
    40. 40. 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
    41. 41. Vulnerable Populations Older adults College students Ethnic minorities Incarcerated persons Military & veterans Women Substance abuse history Mental health history Youth
    42. 42. • 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 memorySource: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):1593-604.
    43. 43. Magical Thinking
    44. 44. Personalization
    45. 45. Cognitive Dissonance
    46. 46. What do you see when you lookbelow?xx xx xx xx(we talked about how the brain is wired to see patterns; this is natural, but for someone prone to a gambling problem this can be a cognitive distortion in seeing patterns in random events)
    47. 47. 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)
    48. 48. 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  More intense sense of shame Use as an escape and guilt (anecdotal) Preoccupation Similar “highs”  Unpredictable outcome Self-help groups  Fantasies of success /quitting Family involvement is giving up hope Use of rituals  Easier to hide Adapted from Andy Cartmill, Washington County H&HS
    49. 49. UO Survey 2010 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.
    50. 50. Name at least three typical consequences that someone may experience due to his/her gambling problem
    51. 51. DebtCrimeDepression/SuicideRelationship problemsEmployment problemsAlcohol and/or drug problems
    52. 52. The average problem gambler in Oregongambling treatment owes $4,000 ingambling-related debts.
    53. 53. The average problem gambler inOregon gambling treatment owes $30,000 in gambling-related debts.
    54. 54. ReferencesAmerican 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, 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. 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 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 , T.L. (2002.) The etiology of pathological gambling. Salem, OR: Department of Human Services.
    55. 55. 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 Human Services. http://www.oregoncpg.comNorthwest Survey & Data Services (2007). Lane County Health & Human Services college gambling survey. Health Authority, Problem Gambling Services (2011). Oregon problem gambling 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 Public Health., D.L., Beason, K.R., & Gilbert, J.D. (2002). Gambling by college athletes: An association between problem gambling and athletes. rockey.pdfShaffer, 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.
    56. 56. problem gambling [Saturday afternoon] Julie Hynes, MA, CPSSubstance Abuse Prevention Program University of Oregon
    57. 57. Name at least three typical consequences that someone may experience due to his/her gambling problem
    58. 58. DebtCrimeDepression/SuicideRelationship problemsEmployment problemsAlcohol and/or drug problems
    59. 59. The average problem gambler in Oregongambling treatment owes $4,000 ingambling-related debts.
    60. 60. The average problem gambler inOregon gambling treatment owes $30,000 in gambling-related debts.
    61. 61. Continuum of CareInstitute of Medicine Continuum of Care
    62. 62. identification &treatment Michele Tantriella-Modell MS, LPC, CADC, NCGCII Director, Emergence Gambling Treatment Program
    63. 63. Continuum of CareInstitute of Medicine Continuum of Care
    64. 64. Identification: Telling theDifference Social Gambler Problem Gambler Occasional Frequent, preoccupied Sticks w/ limits Plays w/needed $, borrowsHopes to win, expects Hopes & expects to WIN to lose Can take it or leave it Primary source of “fun”
    65. 65. Intervention• Helpline 541.741.7107: emergence Or 24/7: 1.877.MY.LIMIT• Referred to provider for assessment• Family members come in; later bring gambler in
    66. 66. Screening: The “Lie-Bet”• Two questions to rule out pathological gambling behavior – 1) 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?• One or both “yes” answers indicate further assessment needed – Further evaluation can be made by calling 1-877-MY-LIMIT
    67. 67. 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)
    68. 68. DSM-IV 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.
    69. 69. Continuum of CareInstitute of Medicine Continuum of Care
    70. 70. Treatment is Free. 24 hrs: 1877-my-limit Online:
    71. 71. Treatment Options in Oregon• Minimal intervention: GEAR (Gambling Education and Reduction)• Outpatient treatment (44)• Crisis respite (2)• Residential treatment (1)
    72. 72. Emergence Gambling TreatmentProgram • Treatment free for gamblers and loved ones – 275 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
    73. 73. Other Facts onGambling Treatment in Oregon• Only about 2% of Oregonians who need treatment enroll• With unstable funding, enrollments dropped 20% in the past year• Those enrolling who lived within a 50 mile radius of a casino were significantly more likely to report casino as their primary venue• 30% enter treatment through the state-wide helpline
    74. 74. 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.
    75. 75. Online: click hereSource: Written by Robert L. Custer, M.D; retrieved from Council on Compulsive Gambling of New Jersey, Inc..
    76. 76. Vulnerable Populations• Older adults• College students• Ethnic minorities• Incarcerated persons• Military & veterans•• Women SA history Tomorrow• MH history• Youth
    77. 77. “Assignment”
    78. 78. Following up on yesterday • South Oaks Gambling Screen (SOGS – Michele discussed this): • Lane County treatment figures from 2010:
    79. 79. Outline:Day 2 • Family dynamics & special populations: Janese Olalde • Recovering problem gambler: Dave is sick  [we decided on video substitution after class: Please watch BBC Documentary for the Discovery Channel (parts 1 – 4) ] • Prevention • Wrapping up
    80. 80. Janese Olalde,MEd, CADC II, CGAC II Family & Special Populations
    81. 81. FAMILY ISSUES
    82. 82. TRUE OR FALSE?Economic Problems are the main reason why a gambler’s relationships end.
    83. 83. False The main reason a gambler’s relationships end is betrayal and distrust.
    84. 84. FAMILY ISSUES Rage and panic Distrust Lost respect Relationships weakened or destroyed Employment affected Financial crisis Reputation damaged
    85. 85. EFFECTS ON FAMILY Worries Unpaid bills Make excuses for gambling Less time with family Partner feels rejected Attempts to control gambling
    86. 86. EFFECTS ON FAMILYIsolationDepression and AnxietyAnger and ResentmentThinking ImpairedDoubts SanityImmobilizationPhysical Symptoms
    87. 87. True or False? The best thing a family member can do to help the gambler is to loan him/her money.
    88. 88. False Bailing out the gambler only perpetuates the problem and the gambling.
    89. 89. Family Financial Issues Create own avenue to financial stability (employment or other) Protect financial assets Close joint accounts Use automatic/electronic deposits for gambler’s income NO BAILOUTS!
    90. 90. Protect Family Get documentation of assets  Retirement accounts  Life insurance policies  College savings funds  Investments• Consult financial specialist or lawyer as appropriate
    91. 91. FAMILY TREATMENT ISSUES Allow venting of rage and betrayal Education of compulsive gambling as an illness Family Groups Renew sense of hope Empowerment Seek support – treatment GAM-ANON DON’T KEEP SECRETS!
    92. 92. Couple Issues in TherapySequencing with individual workAssess possibility of domestic violenceImpact on partner and childrenRole of money in the relationshipDeal with hurt, anger, mistrustDealing with “unfolding truths”
    93. 93. Measuring TrustOn a Scale of 1 to 10: Where is it now? What is the worst it has ever been? What is the best it has ever been? How you would like it to be?Question: What small day-to-day things does it take to move up the scale one point at a time?
    94. 94. 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
    95. 95. THOUGHTS, FEELINGS, ANTICIPATION, FANTASY (Gambler’s Mind, “Gambling Time/Gambling Money”) ACTION CYCLEREALITY(Self with Others,“Real Time, Real Money PLANNING (Removing obstacles to gambling)CRASHGuilt, Shame, Anger, Denial,Justification, Restless, Irritable, GAMBLINGDepression, Panic or Numb, (“Winning & Losing”)Suicidal Thoughts Serotonin Adrenaline Dopamine
    96. 96. ACTION CYCLEThree Ingredients for Gambling: MONEY TIME LOCATIONInterrupt Action Cycle – Create Safety Zone: Barriers to Money Treatment Support Systems Accountability H.A.L.T.S.
    97. 97. Special Populations Youth Senior African American Native American Asian American Hispanic/Latino
    98. 98. YOUTHTeen problem gamblers have higher rates of: Family problems Crime Peer relationship problems Legal and money troubles Depression; suicidal thoughts and attempts Dissociative, “escape” behaviors Risk of other addictions School problems
    99. 99. SENIORIncreased risk due to: Loneliness – (used to socialize) Isolation Physical illness Mental illness or Cognitive Impairment Boredom – lots of free time Other?
    100. 100. AFRICAN AMERICANPOSSIBLE BARRIERS TO SEEKING TREATMENT: Dream of overcoming poverty “Hero” role in family High level of shame Lack of anonymity in small community Sense of independence (“take care of our own”)
    101. 101. AFRICAN AMERICANPossible Barriers: Concern about profiling – might be reluctant to “enter the system” as might be labeled Male and females roles are defined differently than dominant society – more matriarchal Other?
    102. 102. NATIVE AMERICANPOSSIBLE BARRIERS TO SEEKING TREATMENT:• Tradition of gambling in the history• “Save face” if win big and can help family• Social venue for elders• Respect for elders (difficult to confront)• High level of shame on family and generations previous• High probability of cross addiction
    103. 103. NATIVE AMERICAN Limited Native American focused gambling treatment available Lack of a spirituality focus in gambling treatment Availability of gambling activities and gambling establishment-related employment for the community Diversity of tribes with rituals, values and beliefs Other?
    104. 104. ASIAN AMERICANBARRIERS TO TREATMENT: Large diverse Asian population with numerous dialects Widespread use of gambling in Asia High sense of shame related to effects on family Ethic of respect for elders Distrust of dominant society due to history of mistreatment of Asians Isolation - “Invisible” population Other?
    105. 105. HISPANIC/LATINOBARRIERS TO SEEKING TREATMENT: Language/Dialects Isolation Large diverse Latino community Lack of education of compulsive/problem gambling General acceptance of gambling as leisure activity “American dream” to get rich General distrust of dominant society Other?
    106. 106. Continuum of CareInstitute of Medicine Continuum of Care
    107. 107. “The earlier people begingambling, the more likelythey are to experienceproblems from gambling.”- National Academy of Sciences
    108. 108. Not Your Uncle’s GamblingResearchon: Youth gambling still under-studied & under the radar
    109. 109. •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).
    110. 110. Gambling & Oregon Teens• Six in 10 Oregon (63 percent) have gambled• 46 percent gambled in the past year• 3 percent gamble weekly or more• 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; bid).
    111. 111. 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:
    112. 112. 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
    113. 113. 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
    114. 114. 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
    115. 115. 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
    116. 116. 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
    117. 117. 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
    118. 118. Youth gambling and suicideattempts 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
    119. 119. 2010 Oregon Student WellnessSurvey (Lane County)
    120. 120. What’s increasing the most?
    121. 121. Conclusion: Teens who gamble are smoked up, toked up, drunk emo delinquents.
    122. 122. Conclusion: Teens who gamble are smoked up, toked up, drunk emo delinquents.
    123. 123. Problem Gambling isONE COMPONENT of ProblemBehaviors sexual behavior delinquency Problem smoking Behaviors gambling drug use
    124. 124. …yet parents don’t see it. 2010 Oregon Student Wellness Survey, Lane County Parents Discussed Gambling Parents Discussed Substance Use 100 90 80 75.1 Percentage 69.4 70 65.0 61.7 60 50 46.8 40 33.8 30 20 10 0 6th 8th 11th GradeData Source: Oregon Student Wellness Survey, 2010
    125. 125. Targeting Parental AttitudesParental attitudesOregon parent/youth focus groups revealed: – All parents in the groups said their kids didn’t gamble – All kids in the groups said they did gamble – Neither sees gambling as risky
    126. 126. Targeting Parental Attitudes Most parents believe:• Youth gambling is harmless• Youth who gamble are unlikely to have problems in school• Youth gambling is not associated with alcohol or drug use …and those beliefs are part of the problem
    127. 127. Teachers aren’t teaching it.* 2010 Oregon Student Wellness Survey, Lane County Teachers Discussed Gambling Special Class About Substance Use 100 90 80 Percentage 72.3 70 58.8 60 50 43.3 38.9 40 28.9 30 22.2 20 10 0 6th 8th 11th *Most teachers find themselves with less time to address health in general, and are asked to cover a variety of topics. Gradeata Source: Oregon Student Wellness Survey, 2010
    128. 128. Risk Factors • Single-parent household • Started gambling before • Gambling on 8th grade (early cards/sports initiation) • Being male, older teen • Parents who gamble-- • Lower household income youth twice as likely to be at-risk gamblers & • Competitive four times as likely to be • Having lost more than problem gamblers $50 in a single monthSource: Volberg, et al (2008; bid).
    129. 129. Creating conditions in families, schools, andcommunities that promote the wellbeingof people –Emotional and behavioral health –Physical health
    130. 130. Prevention: Statewide & Local Efforts Partnership with Department of Education Curriculum integration in schools Youth video Oregon youth prevalence study Community Resource Guide* Middle School Poster Contest Partnering with addictions prevention providers/groups Policy & coalition work Resource guide can be downloaded at:
    131. 131. • Crashed cars• “Scared straight”• Boot camp• One-time activities
    132. 132. [follow-up link: best practices]
    133. 133. Examples in Lane County
    134. 134. FocusOur efforts have afocus on:• Public awareness• PolicyCurrent focus onLottery marketingpractices
    135. 135. Various Methods
    136. 136. Targeting Those At Higher Risk• Alternative high schools• School counselors• At risk youth programs• Youth detention facilities• Adolescent addiction treatment• School sports
    137. 137. Results• Prevention and awareness efforts in Oregon have been able to avert an increase in the prevalence while facing a dramatic increase in the availability of gambling opportunities.• Local efforts have provided prevention and awareness information to an estimated 1.3 million Oregonians.
    138. 138. Key Challenges in Prevention• Youthful subject• Perception of harmlessness• Stigma/shame• Industry
    139. 139. Class Discussions (what we did in groups)• Poker: Zach & his brother• Casino night discussion• Prevention slogan development• Similarities & differences with problem gambling / other addictions• Non-financial consequences of gambling• Internet – implications of legalizing internet gambling• Treatment: Addressing risky behaviors among potential problem gamblers
    140. 140. Under $100 $1,000-$2,500$100-$1,000 More than $2,500
    141. 141. Problem gamblingtreatment is ‘free’ inOregon for gamblersAND loved ones.
    142. 142. What we discussed. Anythinglingering?• Gambling trends• Addictions connections• The brain• Treatment• Family/multicultural issues• Prevention• The future…
    143. 143. Thank you & best wishes inall you do! For more Info… Julie Hynes, MA, CPS Course questions: Contact info: Lane County Public Health Prevention Program 541.682.3928 |