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Dr. Ken Winters
This is Your Brain on Adolescence: A Developmental
View of Problem Gambling and Other Addictions
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
www.psychiatry.umn.edu/research/casar/home.html
1. Background

4. Summary

3. Neurodevelopment
and gambling

2. Neurodevelopment
#1 Conclusion
Adolescence is a developmental period
often characterized by poor decision
making.
#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.
#2 Conclusion
Brain development may also be a
contributing factor that places youth
at risk for gambling and other
addictive disorders.
#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.
1. Background
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)
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.
U.S. as an Example:
43 states with a lottery (blue)

39 states allow age 18 as legal minimum age
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
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
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+
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.
Point 2: The newest “waves” of gambling expansion,
online gambling and poker, further strengthen
involvement in gambling by teens
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
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
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
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)
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
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
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.
Point 4: There is a developmental feature to
problem gambling

Adolescent
gambling

Adult problem
gambling
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
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.
Point 5: Youth problem gambling
occurs with other problem behaviors

sexual
behavior
delinquency
ADHD
Problem
Behaviors

gambling

male
drug
use
Cross-Sectional Study of Adolescents:
Association of Psychosocial Problems and Gambling Involvement
(Faregh & Derevensky, 2011)

Psychosocial problems
conduct

family
emotional
cognitive

anger

Gambling Group
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
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.
1. Background

2. Neurodevelopment
 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 !
An Immature Brain =

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

reward incentives >
Absence of Judgment
perception of consequences
1. Background

3. Neurodevelopment
and gambling
• youth in general
• ADHD youth

2. Neurodevelopment
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
Point 2: The
neuro-plasticity
of normal brain
development
may contribute
to continued,
and perhaps
accelerated,
gambling
involvement.
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)
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.
Is There a Link between ADHD
and Problem Gambling?
• Adult studies
• Youth studies
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.)
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.)
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.)
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.
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)
1. Background

4. Summary

3. Neurodevelopment
and gambling

2. Neurodevelopment
Summary
1. Evidence is accumulating that…
• most youth gamble, yet many
do so infrequently

• the prevalence of “problem
gambling” is noteworthy
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
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
“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.”
Summary

4. Clinical issue: Screen for
problem gambling among
youth with drug abuse or
ADHD
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.
Brief Screens - Youth

SOGS-RA
• Winters, Stinchfield, & Fulkerson, 1989/1993

DSM-IV-J
• Fisher, 1992
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.
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
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
Summary
CollegeGambling.org
• Tools for
• Students
• College health professionals
• College administrators
THANK YOU!
winte001@umn.edu
extras
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
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
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
Session Evaluation
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
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
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
4. I learned something new
a.
b.
c.
d.
e.

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

Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
6. Please rate this session overall
a.
b.
c.
d.
e.

Very good
Good
Average
Poor
Very poor
Ken Winters. This is Your Brain on Adolescence: A Developmental View of Problem Gambling and Other Addictions

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

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  • 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
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  • 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.
  • 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.
  • 39.
  • 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
  • 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
  • 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
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  • 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
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  • 83. 6. Please rate this session overall a. b. c. d. e. Very good Good Average Poor Very poor