This document provides an overview of gambling and problem gambling. It discusses the history and trends of gambling, defines problem gambling and examines the brain science and connections to addiction and mental health issues. Potential approaches to addressing problem gambling are also mentioned. The document contains information on definitions, the availability of legal gambling, parallels between gaming and gambling, cognitive distortions common in problem gamblers, and vulnerable populations at higher risk.
7. DEFINITION:
______ something of value
RISKING
in the hopes of obtaining
_________________
something of greater
value.
Source: American Psychiatric Association ‐ DSM‐5 (2013).
26. Let’s say there is 1 RED
popcorn kernel in this bag of
10,000 pieces of popcorn
….you’d have a better
chance of reaching in and
grabbing the one red kernel
of popcorn in this bag than
you would of winning
$100 on a powerball ticket
27. So…if your lucky numbers
have “almost” come up in the
last 5 drawings, are your
chances better, worse, or the
same?
40. The new DSM-5 (May 2013) defines
pathological gambling as a
“behavioral addiction,”
the first of its kind.
41. SIMILAR BEHAVIORAL CONDITIONS, like internet and
Binge eating, aren’t yet in the category of
“behavioral addiction.”
(It is thought They might be soon.)
42.
43. IS IT AN “ADDICTION”
1. Solidly established, problematic pattern of a
pleasurable & reinforcing behavior
2. Physiological/psychological components of
behavior pattern that create dependence
3. Interaction of these components in an
individual which makes person resistant to
change
Definition of addiction from Diclemente, 2003
44. IS SOMEONE YOU KNOW…
• Gambling to escape problems
• "Chasing" losses with more gambling
• Lying to family and others about the
extent of gambling
• Committing crimes to finance gambling
• Jeopardizing or losing relationships,
jobs, education because of gambling
• Relying on others to bail him or her
out relieve a desperate financial
situation caused by gambling
61. THOUGHTS, FEELINGS,
ANTICIPATION,
FANTASY
REALITY
(Gambler’s Mind,
“Gambling Time/
Gambling Money”)
(Self with Others)
“Real Time, Real Money”
CRASH
Guilt, Shame, Anger, Denial,
Justification, Restless, Irritable,
Depression, Panic or Numb,
Suicidal Thoughts Dopamine
PLANNING
(Removing obstacles
to gambling)
GAMBLING
(“Winning & Losing”)
Serotonin
Adrenaline
Dopamine
Source: http://www.oregon.gov/oha/amh/gambling/gear‐workbook.pdf
62. WHAT CAN TRIGGER ACTION?
Lots of things, but these are some key triggers.
People at risk should especially avoid gambling when:
H ungry
A ngry
L onely
Tired
63. Comparison by
Start gambling
younger
Start gambling at
older age than men
Tend to like games of
strategy & “action”
(poker, sports bets)
Get addicted faster
Less likely to seek
help
Games of choice:
video slots
More likely to be
“escape” gamblers
These comparisons are of course generalizations and do not by
any means reflect all male and female gamblers.
64. Oregonians in gambling treatment, 2012:
32k
$
IS THE AVERAGE HOUSEHOLD INCOME.
Range is from $0 to over $1million/year.
85% ARE WHITE
. 4.4% Hispanic/Latino., 3.4% Asian.
People of color are under‐represented in treatment.
90%
prefer ELECTRONIC GAMBLING.
24%
HAVE COMMITTED CRIMES TO FINANCE
THEIR GAMBLING. Most crimes are “white collar”
Video (slots/poker/line games).
Cards 4.1%; scratch‐its 1.3%; sports 0.9%;
(forgery, check fraud, embezzlement.)
$!
27k
$
IS THE AVERAGE INDIVIDUAL GAMBLING
DEBT.
65. Comparison of “Action” and
“Escape” Pathological
Gamblers
Action
Escape
Excitement, competition
Relief, escape from stress
“Skilled” forms of gambling
(sports/poker, etc)
“Luck” forms of gambling
(lottery, slots, bingo)
Early onset of gambling
Later onset of gambling
More likely to present
narcissistic or antisocial traits
More likely to present
depressive/dysthymic traits
Source: Center for Substance Abuse Treatment, 2005.
66. CAUSES? (RISK FACTORS)
• Trauma -stemming from
abuse or neglect
• Mental health
issues
• Substance use
• Parental
attitudes &
behavior
• Competitive
family
• Community
norms/laws
• Early
initiation
• Friends
favorable
toward
gambling
67. At what age is the
brain considered
fully developed?
18
21
25
16
70. Depression/mood disorders
Narcissistic personality disorder
PTSD
Impulsivity
ADHD
Substance abuse
Alcohol abuse
Sources 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)
71. It’s really about the
action, not the money!
“ALMOST
WINNING”
causes
dopamine to
be activated
the same as
ACTUALLY
winning.
People play
LONGER
when
machines
give them
NEAR
MISSES.
Problem
gamblers are
more likely to
see their near
misses as
“NEAR WINS”
For more info: see article
“The Almost Winning Addiction” in the readings.
73. Gambling & Dopamine
It’s not about the money – it’s about the action of the game and the hope of
winning.
Dopamine not released when expecting a loss.
Flooded with dopamine when expecting a win!
Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC
76. COGNITIVE Distortions
Biased Evaluation
Attributing wins to one’s special
skill or luck, while losses are
blamed on external circumstances.
Example (win): “Yeah buddy! I was just waiting on my
card. I know this game inside and out.”
Example (loss): “I would’ve won if that idiot didn’t get
lucky and draw an ace.”
99. Effects of Problem Gambling on
Children
• 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
100. “The earlier people begin
gambling, the more likely
they are to experience
problems from gambling.”
- National Academy of Sciences
107. RISK FACTORS FOR YOUTH
• Single‐parent household • Started gambling before
8th grade (early
• Gambling on
initiation)
cards/sports
• Being male, older teen • Parents who gamble‐‐
youth twice as likely to
• Lower household
be at‐risk gamblers &
income
four times as likely to be
• Competitive
problem gamblers
• Having lost more than
$50 in a single month
Source: Volberg, et al (2008; bid).
108. 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).
109. Lane County 2012
Student Wellness Survey (SWS)
2012 Gambling, Substance Use and Mental Health
among Oregon Youth
50%
Percentage
40%
6th
30%
11th
20%
10%
0%
Gambling Alcohol
Binge Marijuana Cigarettes Depression Psych
Alcohol
distress
Source: http://oregon.pridesurveys.com/esds.php?year=2011
n=55,611 students (18,885 6th grade; 21,368 8th grade; 15,358 11th grade)
8th
110. Used alcohol in the past month
100%
90%
80%
70%
Percentage
60%
50%
Did not gamble
40%
Gambled
30%
20%
10%
0%
Grade 6
Grade 8
Available at: www.preventionlane.org/sws.htm
Grade 11
111. Binge drank in the last 30 days
50%
45%
40%
Percentage
35%
30%
Did not gamble
Gambled
25%
20%
15%
10%
5%
0%
Grade 6
Grade 8
Available at: www.preventionlane.org/sws.htm
Grade 11
112. Smoked cigarettes in the past
month
50%
45%
40%
Percentage
35%
30%
Did not gamble
Gambled
25%
20%
15%
10%
5%
0%
Grade 6
Grade 8
Available at: www.preventionlane.org/sws.htm
Grade 11
113. Used marijuana in the past month
50%
45%
40%
Percentage
35%
30%
25%
Did not gamble
20%
Gambled
15%
10%
5%
0%
Grade 6
Grade 8
Available at: www.preventionlane.org/sws.htm
Grade 11
114. Percentage
Skipped school one or more days
in the past month
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Did not gamble
Gambled
Grade 6
Grade 8
Available at: www.preventionlane.org/sws.htm
Grade 11
115. Percent of youth who
attempted suicide in the
past year
30%
Percentage
25%
20%
Did not gamble
15%
10%
11.3%
7.2%
5%
9.0%
5.0%
0%
Grade 8
Available at: www.preventionlane.org/sws.htm
Grade 11
Gambled
116. Percent of youth that attempted
suicide in the past year
30%
Percentage
25%
21.0%
18.6%
20%
15%
10%
10.1%
Did not
bet/gamble more
than wanted to
8.0%
Bet/gambled
more than
wanted to
5%
0%
Grade 8
Grade 11
119. Conclusion: Problem Gambling
is
ONE COMPONENT of
Problem Behaviors
delinquency
sexual
behavior
Problem
depression
Behaviors
gambling
substance
use
124. A Simple Screen: Lie-Bet Tool
(Johnson et al., 1988)
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?
Valid and reliable for ruling out pathological gambling behavior
Response to ONE or both indicates referral for longer assessment
useful in screening to determine whether a longer tool (e.g., SOGS, DSM‐IV)
should be used in diagnostics
126. DSM Criteria Revisited
1.
2.
3.
4.
5.
Preoccupation
with gambling
Increases amount
of money gambled
Unsuccessfully
tries to quit
Restless or
irritable when
trying to cut
down/stop
Gambles as an
escape
6.
7.
8.
9.
“Chases” losses
Lies to others to
conceal gambling
Has jeopardized
relationships
Relies on others
to bail him/her
out
Gambling Disorder =
Four or more of above, AND: The gambling behavior is not
better accounted for by a Manic Episode.
129. EMERGENCE GAMBLING
TREATMENT PROGRAM
Treatment free for gamblers and loved ones
275 problem gamblers and family members
treated last year
Gender-specific
Multimodal treatment
Individual sessions
therapy
Group sessions
counseling
Didactic lectures
- Family
- Recreational
- Audiovisual educ.
Suggest to explore 12‐step program
134. 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!
Slide credit: Janese Olalde, MEd, CGAC, CADC
135. 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”
Slide credit: Janese Olalde, MEd, CGAC, CADC
139. Awareness & communication of
the problem is relatively low.
2012 Oregon Student Wellness Survey, Lane County (“Esd”) and Oregon;
available at http://oregon.pridesurveys.com/esds.php?year=2011
141. 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
148. KEY CHALLENGES IN THE
FIELD
• Youthful subject
• Perception of
harmlessness
• Stigma/shame
• Industry
149. IS IT “SOCIAL” OR PROBLEM
GAMBLING?
Social Gambler
Problem Gambler
Occasional
Frequent, preoccupied
Sticks w/ limits
Plays w/needed $, borrows
Hopes to win, expects to lose
Hopes & expects to WIN
Can take it or leave it
Primary source of “fun”
150. 10 TIPS FOR RESPONSIBLE
GAMBLING
1. Gamble only if it's fun.
2. Think of the money you lose as the cost of
entertainment.
3. Set a dollar limit and stick to it.
4. Set a time limit and stick to it.
5. Accept losing as part of the game.
151. 10 TIPS FOR RESPONSIBLE
GAMBLING
6. Don't borrow money to gamble.
7. Don't let gambling interfere with family, friends,
or work.
8. Don't gamble to win back losses.
9. Don't use gambling as a way to cope with
emotional or physical pain.
10. Know the warning signs of problem gambling.