Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions Session 7B Presented at the New Horizons in Responsible Gambling Conference in Vancouver, January 27-29, 2014

3. Dr. Ken Winters
This is Your Brain on Adolescence: A Developmental
View of Problem Gambling and Other Addictions

4. This is Your Brain on Adolescence: A Developmental View
of Problem Gambling and Other Addictions
Ken Winters, Ph.D.
Professor, Department of Psychiatry
University of Minnesota
Minneapolis, MN USA
winte001@umn.edu
New Horizons in Responsible Gambling
Conference
Vancouver, CA
January 29, 2014

5. www.psychiatry.umn.edu/research/casar/home.html

10. 1. Background
4. Summary
3. Neurodevelopment
and gambling
2. Neurodevelopment

11. #1 Conclusion
Adolescence is a developmental period
often characterized by poor decision
making.

12. #1 Conclusion
Adolescence is a developmental period
often characterized by poor decision
making.
Brain maturation may be a significant
determinant of tendencies for nonthoughtful decision making.

13. #2 Conclusion
Brain development may also be a
contributing factor that places youth
at risk for gambling and other
addictive disorders.

14. #3 Conclusion
Most adult gamblers begin to gamble
in their youth; early onset gambling is
a common feature of the pathway
toward developing a gambling
problem.

15. 1. Background

16. Terms of “severe-end” gambling often
used when referring to youth
•
Gambling Disorder (DSM-5) (GD) = repeated and
compulsive involvement in gambling that
continues in the face of financial, social,
psychological and vocational consequences.
(level 4)
•
Problem gambling (not official) = gambling that
contributes to financial, social, legal, psychological,
school and vocational consequences
(level 3)

17. Point 1: First generation of youth exposed to ready
access and varied gambling venues
• Minimum legal age to place a
bet varies across countries
and games, but many
opportunities for youth in the
Westernized countries.

18. U.S. as an Example:
43 states with a lottery (blue)
39 states allow age 18 as legal minimum age

19. U.S. as an Example
43 states with casino/slots
14 states allow 18 as legal minimum age
casinos/slots not legal
casinos/slots legal
casinos/slots legal

20. U.S. Study: Youth Participation in Gambling
(age 14 – 21)
(Welte et al., 2008)
70
68
percent
60
50
40
30
33
30
29
23
20
21
12
10
0
cards
office pools
lottery
sports
betting
skill games
bingo
9
dice games
7
casino
all gambling

21. U.S. Study: Past Year Problem Gambling
Prevalence Rate by Age Group
(Welte et al., 2002, 2008)
10
Some epidemiology
studies estimate teen
rates are higher than
adult rates
percent
8
6
5.2
4.3
4
2
3.3
3.3
2.1
1.3
1.2
0
<19
19 - 25
26-30
31-40
41-50
51-60
61+

22. U.S. Data: Estimates of Problem Gambling, Past Year
(included U.S. and Canada data; school-based surveys)
(National Research Council, 1999)
Percentage
Group
Adult
Adolescent
Range
Median
<1 - 2%
0.9%
1 - 9%
6%
Estimates based on meta-analysis of surveys conducted 1988-1997 (National Research Council, 1999).
Problem gambling defined in most studies by the SOGS/SOGS-RA.

23. Point 2: The newest “waves” of gambling expansion,
online gambling and poker, further strengthen
involvement in gambling by teens

24. Online Gambling (internet, online,
social networks)
• Various forms of online gambling are legal and regulated in
many countries
• U.S. – very limited; permitted in some States
• U.K. and Australia – examples of relatively permissive internet
regulations
• Recommended reading:
Remote gambling in adolescence
Griffiths, Parke, & Derevensky (2010). In J. Derevensky, D. Shek &
J. Merrick (Eds.), Youth gambling problems: The hidden addiction.
Berlin: De Gruyter

25. Gambling Severity by Sample
(McBride & Derevensky, 2007)
80
70
Frequency %
60
50
High School
College/University
Internet Sample
40
30
20
10
0
Non-gambler
Social gambler
Problem gambler

26. University journalism student Mike Schneider won top prize
- $1 million - in the Limit Hold'em PartyPoker.com Million V
tournament.
Photo by Charlie Knutson, from The Minnesota
Daily, March 22, 2006

27. Point 3: There is a disconnect between estimates of
youth problem gambling and utilization of clinical
services
• From 1999- 2009 in Minnesota:
• over 10,000 calls to the problem gambling
hotline …
15
calls pertained to teen gambling (< 19 years old)
• over 3,700 referrals to a treatment
program…..
0
referrals of teenagers (< 19 years old)

28. Point 3: There is a disconnect between estimates of
youth problem gambling and utilization of clinical
services
• From 1999-2009 in Minnesota:
• over 10,000 calls to the problem gambling
hotline …
14
calls from teenagers (<19 years)
• over 3,700 referrals into the treatment
system…..
19
referrals of 19 – 25-years old

29. Why?
• Low public awareness
• Low problem recognition
• No youth-specific services
• Other, more observable problems are
viewed as more pressing
• No or minimal financial losses

30. But there are clinical cases
• Minnesota High School Football Star; was an
honor student and had a football scholarship
to a Division I school.
• Became an habitual blackjack player at the
local casino after he turned 18.
• To finance his habit, he fenced stolen
property.
• Was arrested for the thefts.

31. Point 4: There is a developmental feature to
problem gambling
Adolescent
gambling
Adult problem
gambling

32. Onset of Gambling Variables and Number of
Lifetime Symptoms (Kessler et al., 2008)
Age Onse
Gambling
30
mean age
Earlier onset among those 5+
25
23.9
20
18
18.3
16.7
15
10
5
0
No Sym
1-2 Sym
3-4 Sym
5+ Sym
Age Onset: F = 15.4, p < .001

33. Onset of Gambling Variables and Number of
Lifetime Symptoms (Kessler et al., 2008)
Age Onset
30
Age Onset Prb
24.3
mean age
26.7
25
23.9
23.8
20
18
18.3
16.7
15
10
5
0
0NA
No Sym
1-2 Sym
3-4 Sym
5+ Sym
Age Onset Prb: non sig.

34. Point 5: Youth problem gambling
occurs with other problem behaviors
sexual
behavior
delinquency
ADHD
Problem
Behaviors
gambling
male
drug
use

35. Cross-Sectional Study of Adolescents:
Association of Psychosocial Problems and Gambling Involvement
(Faregh & Derevensky, 2011)
Psychosocial problems
conduct
family
emotional
cognitive
anger
Gambling Group

36. Longitudinal Study of Youth:
Association of Psychosocial Problems and Future Gambling
(Pagani et al., 2009)
• These variables measured in the kindergarten
sample:
•
•
•
•
•
•
Impulsivity
Emotional distress
Family functioning
Maternal education
Parental gambling
Gender
• Measured gambling behavior when they were sixth
graders.
Pagani et al., 2009

37. Childhood Self-Control (Age 3) as a Predictor of Adult
(Age 21) Problem Gambling (Slutske et al., 2012)
undercontrolled group > gambling
The children with undercontrolled temperament
at 3 years of age were more than twice as likely
to evidence disordered gambling at ages 21
than were children who were well-adjusted at
age 3.

38. 1. Background
2. Neurodevelopment

40.  Adolescence is a period
of profound brain
maturation.
 We thought brain
development was
complete by
adolescence
 We now know…
maturation is not
complete until about
age 25 !

41. An Immature Brain =
Less Brakes on the “Go” System

42. Maturation Occurs from Back to Front of the Brain
Images of Brain Development in Healthy Youth
(Ages 5 – 20)
Earlier:
Motor Coordination
Emotion
Motivation
Later:
Judgment
Blue represents maturing of brain areas
Source: PHAS USA 2004 May 25; 101(21): 8174-8179. Epub 2004 May 17.

43. Implications of Brain Development for Adolescent Behavior
•
Preference for ….
1. physical activity
2. high excitement and rewarding activities
3. activities with peers that trigger high
intensity/arousal
4. novelty
•
Less than optimal..
5. control of emotional arousal
6. consideration of negative conseq.
•
Greater tendency to…
7. be attentive to social information
8. take risks and show impulsiveness

44. Novelty Activates the Dopamine System
• Compared to adults, adolescents
have lower baseline levels of
dopamine activity and greater
sensitivity to dopamine-triggering
activities, such as novelty.
• Thus, adolescents may seek
novelty more and may experience a
greater reward from novelty as a
result of this „robust‟ dopamine
system.

45. Implications of Brain Development for Adolescent Behavior
•
Preference for ….
1.
2.
3.
4.
•
physical activity
high excitement and rewarding activities
activities with peers that trigger high intensity/arousal
novelty
Less than optimal..
5. control of emotional arousal
6. consideration of negative conseq.
•
Greater tendency to…
7. be attentive to social information
8. take risks and show impulsiveness

46. Risk-Taking
• Based on science of brain development, a modern
view of risk taking in adolescence …
• is normative; important to development
• has evolutionarily adaptive value
• significant individual differences
• not a result of poor assessment of risk; rather, is due
primarily to self-control and contextual factors, not
cognitive influences

47. An Immature Brain
=
Low Brain Power

48. An Immature Brain
=
reward incentives >
Absence of Judgment
perception of consequences

49. 1. Background
3. Neurodevelopment
and gambling
• youth in general
• ADHD youth
2. Neurodevelopment

50. Point 1: Normal brain development may
contribute to adolescent susceptibility to
gambling involvement.
•
Preference for ….
1.
2.
3.
4.
•
Less than optimal..
5.
6.
•
physical activity
high excitement and rewarding activities
activities with peers that trigger high intensity/arousal
novelty
control of emotional arousal
consideration of negative consequences
Greater tendency to…
7.
8.
be attentive to social information
take risks and show impulsiveness

51. Point 2: The
neuro-plasticity
of normal brain
development
may contribute
to continued,
and perhaps
accelerated,
gambling
involvement.

52. Point 3: ADHD may put a person at heightened
risk for gambling involvement
• Individuals with ADHD suffer from
problems with judgment and selfregulation, believed to be linked to prefrontal cortex deficits.
• These deficits in pre-frontal cortex
contribute to a disorder likely related to
another addictive disorder - drug
addiction.
(Barkley, 1997; Martin, Earlywine, Blackson et al., 1994)

53. Link of ADHD and Drug Abuse
adapted Molina et al., unpublished
Teenagers with a
childhood diagnosis of
ADHD are about 2 – 4
times more likely to
have a Substance Use
Disorder compared to
teenagers without
ADHD.

54. Is There a Link between ADHD
and Problem Gambling?
• Adult studies
• Youth studies

55. Adult: Link of ADHD and Gambling Disorder
Among Adults With and Without a Gambling Disorder
(Carlton et al., 1987; Rugle & Melamed, 1993)
Gambling Disorder
Rate of childhood ADHD
15-36%
psych., non-GD
4-8%
(sig.)

56. Adult: Link of ADHD and Gambling Disorder
Among Adults With and Without a Gambling Disorder
(Specker et al., 1995)
Gambling Disorder
Rate of adulthood ADHD
21%
psych., non-GD
< 1%
(sig.)

57. Adult: Link of ADHD and Gambling Disorder
Among Adults With and Without ADHD
(Harrow, 2009)
Gambling Disorder
Rate of adulthood GD
12%
controls
< 1%
(sig.)

58. Youth: Link of ADHD and Problem Gambling
Association of Adolescent Gambling and Probable ADHD Status 1
(Derevensky et al., 2007)
“ADHD”+
Groups (N = 2336)
“ADHD”-
(n = 231)
%
(n =2105)
%
Nongamblers (30%)
6
94
Social
8
92
At-Risk (8%)
20
80
Prob. Path. (5%)
34
66
1
(54%)
Based on the ADHD Index (Conners & Wells, 1997)
X2 = 113, p < .001
Derevensky JL, Pratt LM, Hardoon KK, Gupta R. (2007). Gambling problems and features of attention deficit hyperactivity disorder among
children and adolescents. Journal of Addiction Medicine, 1, 165-172.

59. Youth: Link of ADHD and Problem Gambling
Minnesota ADHD Study
(Breyer, Winters, August, & Realmuto, 2009)
ADHD-persis
ADHD-desist
Controls
sig.
any gambling (%)
79
77
80
PG among all1 (%)
19
5
5
PG among gamb1 (%)
24
7
7
SOGS-RA score (mean)
0.5
0.2
0.2 (p < .05)
Count games played (mean)
3.0
2.4
2.7
1
PG = SOGS-RA 2+
(p < .05)
(p < .01)

60. 1. Background
4. Summary
3. Neurodevelopment
and gambling
2. Neurodevelopment

61. Summary
1. Evidence is accumulating that…
• most youth gamble, yet many
do so infrequently
• the prevalence of “problem
gambling” is noteworthy

62. Summary
2. Possible links between
neurodevelopment and gambling
behavior
• Gambling may be a very attractive activity
for the developing brain
• Neuro-plasticity may impact future risk.
• Deficits in brain structures responsible for
self-regulation may place youth with ADHD
at elevated risk for problem gambling

63. Summary
3. Relatively easy access to
online gambling and
popularity of poker games
and tournaments poses a
new risk for youth who
may be inclined to overindulge in e-gambling

64. “Maryland CPA hit it big, but he worries about
those who won’t”
(Jon Saraceno, USA Today, August 1, 2006)
“Steve Dannenmann, who honed his skills with online poker-playing, won $4.25 million
as runner-up in the 2005 World Series of Poker tournament.
This summer, while playing poker in Vegas for a few weeks, he has made it his personal
project to quiz young people who have fallen for the allure of the game and its potential
financial bonanza.”
Steve: “I‟ve met so many kids who have packed it in and came out here with a $2,000-$3,000
bankroll thinking they‟re going to make it big. They‟ve quit college or their jobs. I quiz them
like I do my clients who come in with money concerns.”
„Why did you quit school? What‟s your bankroll? What is your back-up plan?‟
“If they don‟t give a good answer, I call their bluff.”
„What are you thinking?‟
“It‟s absolutely crazy, and pretty sad.”

65. Summary
4. Clinical issue: Screen for
problem gambling among
youth with drug abuse or
ADHD

66. Brief Screen - Adult
Lie/Bet Screen
(Johnson et al., 1997)
2-question version of the DSM-5 criteria:
1. Have you ever had to lie to people important to
you about how much you gambled?
2. Ever felt the need to bet more and more
money?
Score of 1+ is a red flag.

67. Brief Screens - Youth
SOGS-RA
• Winters, Stinchfield, & Fulkerson, 1989/1993
DSM-IV-J
• Fisher, 1992

68. Sampling of Themes from Adolescent
Problem Gambling Screens
1. There is money missing from the parents.
2. The teenager asks for an increase in
allowance.
3. The parent finds evidence of internet
gambling when searching the teenagers
computer.
4. The teenager is secretive about how they are
spending their money.

69. Summary
5. Clinical issue: For youth being
treated for a substance use
disorder or ADHD:
•raise insights as to the risks of
gambling; educate that gambling may be
a source of relapse

70. Summary
• 6. Prevention programs exist
• Gambling prevention can be integrated
into a school‟s drug prevention program
• International Centre for Youth Gambling
• www.youthgambling.com/
• Illinois Institute for Addiction Recovery
• www.addictionrecov.org
• Williams, Woods & Currie: Stacked Deck

71. Summary
CollegeGambling.org
• Tools for
• Students
• College health professionals
• College administrators

72. THANK YOU!
winte001@umn.edu

73. extras

74. Internet and Youth Study
(McBride & Derevensky, 2007)
• High-school students, Montreal: N = 1113
• College/University students, Canada and
U.S.: N = 1273
• Young adults and adults, on-line gaming
newsletter link: N = 546

75. Gambling for Money on the Internet
(McBride & Derevensky, 2007)
Frequency %
100
90
80
70
60
High School
College/University
Internet Sample
50
40
30
20
10
0
never
less than once
a month
monthly
weekly

76. Past Year Gambling
(McBride & Derevensky, 2007)
100
90
Frequency %
80
70
High School
College/University
Internet Sample 18-24
Internet Sample 25+
60
50
40
30
20
10
0
Male
Female

77. Session Evaluation

78. 1. The information presented was useful to me
a.
b.
c.
d.
e.
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree

79. 2. The information presented was clear and organized
a.
b.
c.
d.
e.
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree

80. 3. I would recommend this session to a friend/colleague
a.
b.
c.
d.
e.
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree

81. 4. I learned something new
a.
b.
c.
d.
e.
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree

82. 5. The presenter(s) was/were engaging
a.
b.
c.
d.
e.
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree

83. 6. Please rate this session overall
a.
b.
c.
d.
e.
Very good
Good
Average
Poor
Very poor