Monthly Treatment Call Presentation/Minutes - Mar2015

1. Problem Gambling Treatment
Providers
Monthly Call/Webinar
March 4, 2015
Facilitated by Greta Coe

2. 2
Agenda
Time Topic
3:00pm-3:10pm Introductions/County Roll Call
3:10pm-3:15pm AMH Update/Announcements
•PG System Improvement Community Forums
3:15pm-3:45pm Presentation
•GBIRT Screening Project- Presented by Alicia Bartz
(Multnomah County) and David Corse (VOA/InAct- Mult.
Co.)
3:45pm-3:55pm Discussion Topics
•PGS Treatment Provider Discussion-Updates from the field
3:55pm-4:00pm Wrap Up
Items for next meeting?
Future agenda items:
•Quality Improvement Reports- as statewide look and
performance based contracting (April)
•MH clinicians not knowing how to refer and screen
•Treating gambling addiction and co-occurring disorders
•Ideas for increasing enrollments

3. 3
AMH Updates
 PGS System Improvement Community Forums
March 10, 2015- Lake Oswego
March 12, 2015- Grants Pass
March 13. 2015- Albany
March 17, 2015- Bend
 Contact Patricia.alderson@state.or.us for registration flyer. Registration closes
on Friday, March 6.

4. 4
Presentation
GBIRT Screening Project
Presented by Alicia Bartz (Multnomah County)
and David Corse (VOA/InAct- Mult. Co.)

5. 1. Evidence of high risk of gambling problems among
individuals diagnosed with substance use and mental
health disorders.
2. Not addressing gambling issues decreases treatment
effectiveness and adds to treatment costs
3. Early intervention and treatment work!
Why bother screening for gambling
disorders?

6. • Per DSM5, those with gambling disorder have high rates of
substance use disorders, depressive disorders, anxiety
disorders, and personality disorders.
• Up to nearly 1/3 of individuals in SUD treatment identified
as problem gamblers (Ledgerwood et al, 2002)
• The more severe the past year’s SUD, the higher the
prevalence of gambling problems (Rush et al, 2008)
• Individuals with lifetime history of mental health disorder
had 2-3 times rate of problem gambling (Rush et al, 2008)
Comorbidity

7. OSAM Survey
27.6% gambled more when using alcohol or other drugs
16.7% used more alcohol or drugs when gambling
15.6% gambled to buy alcohol or drugs

8. • What happens in actual clinical practice
• Use screen
• No one endorses items
• What does counselor think?
• None of my clients have any gambling problems
• Don’t care about the research, my clients are different
• NIMBY (Not in my back yard (or treatment program))
Typical results of use of brief screens

9. Need to define what is meant by gambling – list types of
gambling
Use diagnostic criteria
Developed to screen for most severe gambling problems
Differing ways questions are addressed by counselors; many
factors including counselor workload, length of intake
assessments, counselor priorities, and counselor comfort
with problem gambling all may contribute to minimizing
importance of gambling questions
Issues with brief screens

10. Counselor thinking: “I can save time on these…That’s not why she
is here anyway.”
“ You’ve never lied about gambling or wanted to spend more
money on it, have you? “
Client thinking: “Phew! Nobody cares about gambling here! No,
that’s not a problem”
PG screening: what often happens

11. • For the purpose of the next questions, “gambling”
means buying lottery tickets, gambling at a casino,
playing cards or dice for money, betting on sports
games, playing slot machines, video poker or other
video gambling, gambling on the internet, betting on
horses or dogs, playing bingo or keno.
• During the past 12 months, have you gambled 5 or
more times?
• If yes, continue to next 3 questions:
Strategy adapted from IL SBIRT*
*from DSM-5, BBGS, and Elizabeth Hartney, PhD

12. During the past 12 months:
1. Have you tried to hide how much you have gambled from your family or
friends?
2. Have you had to ask other people for money to help deal with financial
problems that had been caused by gambling?
3. Have you ever felt restless, on edge or irritable when trying to stop or
cut down on gambling?
If yes to any of the above, proceed to next 6 questions:
Screening strategy

13. 4. Have you tried to cut down or stop your gambling?
5. Have you increased your bet or how much you would spend, in order
to feel the same kind of excitement as before?
6. Did you think about gambling even when you were not doing it?
(Remembering past gambling experiences, or planning future
gambling?)
7. Did you go to gamble when you were feeling down, stressed, angry or
bored?
8. Did you ever try to win back the money that you had recently lost?
9. Has your gambling caused problems in your relationships or with work?
Total “yes” responses?
Screening strategy, continued

14. A “yes” response to any of questions 1, 2, or 3 results in
asking all the questions (4-9) and Gambling Brief
Intervention.
•A “yes” response to a total of 4 questions (out of 9) results
in a Gambling Brief Intervention and Referral to Gambling
Treatment
Brief intervention

15. • Give feedback on personal gambling
• Define levels of gambling and gambling disorder
• Go over risk factors for problem gambling/gambling disorder
(i.e., being in recovery, dealing with grief or loneliness, or
immediate financial pressures)
• Offer steps to keep gambling fun and problem-free: set a time and
money limit and stick to it; learn how the games work and what
they cost to play; balance with other leisure activities
• “If you gamble and spend more time and money than you can
afford, a good strategy is to take a break and look at your
gambling. Consider seeking help if this is a concern.”
Brief advice on reducing gambling

16. The key to this approach is to raise the issue of gambling and
its role in your client’s recovery in multiple contexts and
repeatedly over time.
It is also key to include the topic of gambling in a non-
judgmental or labeling manner, in order to minimize
defensiveness or resistance.
Integrated assessment

17. What we’re doing
GBIRT
Utilize previously-described gambling screening techniques
with clear routes to referral
Peer mentors
Educate A&D (alcohol and drug) providers and conduct
outreach to A&D clients with gambling issues to provide
support and link to treatment

18. Planning and evaluation
Two of our providers have both gambling and A&D branches
in their organizations
The issue: minimal overlap/communication
Piloting GBIRT and mentors at one organization (VOA), not
the other (Cascadia, control group)
Also piloting mentors at A&D-only organizations

19. Examining the need
Conducted gambling attitude and knowledge surveys at VOA
among all consenting staff and clients to establish baseline,
Dec. 2014
Questionnaire adapted and expanded from Lori Rugel’s GBIRT
evaluation, available online.
Similar baseline conducted at Cascadia, Mar. 2015, for
comparison (data forthcoming)
Both organizations tracking the number of identifications and
referrals for gambling issues discovered among A&D clients
each month

20. The need
31 staff and 83 clients participated at VOA, with a median time in
treatment of 3 to 6 months
Results
Nearly 90% of clinical staff indicated that they had spoken with
clients about gambling problems before; however, only 34% of
clients recalled their counselor ever mentioning it.
Clients for whom this would not be relevant may have difficulty
remembering; however, this also held for active gamblers—one-third of
those who gambled at least once a month reported never having been asked
about it before.
Nearly 22% of clients gambled at least once a month; 10% gambled weekly
or more.
 Games of choice: in-person machine games (such as slots and video poker)
and lotteries (such as PowerBall and scratch tickets) were the top two
games among weekly to daily gamblers.

21. The need
Results, continued
Knowing where to get help for gambling problems: while
100% of staff reported of available resources they could access
if they needed help, only 60% of clients did (despite receiving
treatment at an organization with a gambling program).
Ready to help: staff were near-neutral on their self-perceptions
of their ability to help clients with gambling issues, as well as on
if a client would feel comfortable coming to them with such an
issue. There was some agreement that their department needed
to do more to address gambling, as well as acknowledgment
that they had heard leadership address gambling as an issue.

22. The need
Results, continued
Community impact: over 90% of staff acknowledged that at
least one form of gambling had a negative impact on their
community; only 35% of clients believed this to be true.
In-person machine games, such as slots, keno, or video poker, was
identified as the number one problematic type of game.
Personal beliefs: clients and staff strongly believed gambling to
be as addictive as alcohol or drugs and that it was important to
provide professional help, although clients were more neutral
on the origins of gambling problems than staff (whether it is a
simple result of greed/lack of self-control), and on whether
addressing gambling addictions should be as high a priority as
A&D addictions.

23. In summary
This baseline shows receptiveness to learning more about
gambling and improving outreach, but a lack of comfort
among staff with addressing gambling issues, a lack of
knowledge among clients as to how harmful it can be, and a
disconnect between client and staff knowledge of what
assistance is available
Thus, room to grow!

24. 24
Questions

25. 25
Future Agenda Items
APRIL: Quality Improvement Reports- as statewide
look and performance based contracting
MH clinicians not knowing how to refer and screen
Treating gambling addiction and co-occurring disorders
Ideas for increasing enrollments

26. 26