1. INVESTMENT IN THE INTERVENTION OF YOUTH PROBLEM
GAMBLING
Policy Proposal
F. Grazioli, NYU Silver School of Social Work, for Advanced Social Policy in Substance Abuse, Spring 2016
Background
Problem gambling (PG) is a process-addiction disorder that afflicts more than 6 million adults in the United States and
evidences behavioral symptom activation of reward systems also seen in substance abuse disorders. Youth problem
gambling (YPG, affecting those ages 13-17) manifests typically in chance (sports betting, lottery) and games of strategy
(card games, fantasy leagues). Treatment and legal remediation of PG cost US taxpayers $6.1 billion in 2013. [6]
Adults in the U.S. with gambling addiction—the most severe form of PG—report initiation of gambling activity at an
early age of 12 years, on average. [11] YPG affects up to one-half million youth in the United States and the consequences
of YPG are swift, and for the concerned others often financially catastrophic (e.g. stolen credit cards). A small but growing
body of literature examining YPG cites general lack of longitudinal study, which will be essential in mapping and
understanding the trajectory of an evolving public health concern that is YPG.
FACT CHECK: [6]
 48 of 50 US states allow gambling; armed with technology youth effectively have access to gambling in all 50 states
 80% of all high school students report having gambled money in the past 12 months
 39 states provide differing levels of subsidized treatment for problem gambling with per capital investment ranging
from $0.01 to $1.16 (substance use prevalence is 3x that of PG, yet is funded at 281x rate of addressing PG)
 Whereas 2-3% of adult gamblers have a gambling problem or addiction; up to 6% of youth who gambling report
problem or addictive gambling, at 10-14% are further considered at risk of developing PG
There is no body at the federal level charged with coordination and regulation of effort to address problem gambling; YPG
present a particularly vulnerable population whose trajectory foreshadows longer term, more lasting negative outcomes.
YOUTH PROBLEM GAMBLERS: THE ODDS ARE STACKED AGAINST THEM: [6]
Without intervention, by the time a youth problem gambler reaches adulthood he or she is:
 2 times more likely to develop gambling addiction
 2-3 times more likely to use drugs, binge drink
 3-5 times more likely to engage in criminal behavior (e.g. theft, racketeering, gangs)
 5-7 times more likely to experience other physical and mental health issues such as coronary disease and
depression
 20-25% of problem gamblers in 12-steps groups and in individual treatment report having attempted suicide.
Proposal
Establish a federal governing body to study, recommend, fund, and ensure oversight of equitable investment in prevention,
education, treatment, enforcement, and research into YPG1
.
Mandate measurable efficacy and cost efficiency in this body’s remit by including:
 Collaboration between public and private sector interests
 Review, application/adaptation or improvement of existing evidence-based interventions (EBI) and other programs
that have been show to demonstrate positive outcomes in other behavioral health settings (e.g. substance abuse)
and anticipate concern around containing and optimizing health care cost
 Provision of a guarantee for program evaluation and research in service gap analysis, including longitudinal study
for measuring and reporting long-term outcomes to stakeholders (e.g. taxpayers, private interest)
 This proposal includes a matrix of specific Recommendations as part of a systemic, public-private sector
collaboration (below).
1 The five areas of investment are a subset of PETERRR (Prevention, Education, Treatment, Enforcement, Research, Responsible Gaming, Recovery), focal
areas for intervention for problem gambling, conceptualized for address to the New York State Gaming Commission at its Forum on Problem Gambling, and
presented April 9, 2014 by Keith Whyte, Executive Director, National Council on Problem Gambling. http://www.ncpgambling.org/wp-
content/uploads/2014/08/NCPG-Statement-to-NYSGC-April-9-2014.pdf

2. Recommendations for Implementation
The following comprise this proposal’s inventory of EBIs and funding streams foundational for collaboration.
Aims Intervention Opportunity and Rationale
Prevention,
Treatment
Enforcement
Mobile technology (mTech) User experience (UX) “built-ins” such as persistent clocks to meter play on
device, account ownership limits, and activity history provide transparency
into real-time engagement. De-identified user data for play devices can be
mined for analysis for intervention strategy planning and implementation. [4]
Improve and enforce more stringent age verification.
Use peer-generated content to foster responsible play and educate about
risks. [3, 12]
Grant favorable business relief and incentives (e.g. abatements) to attract
talent and ethical investment in addressing YPG.
Education,
Treatment
Screen-Brief Intervention-Refer
to Treatment (SBIRT) in Primary
Care (PC) settings using short
item screeners
Cognitive behavioral therapy
(CBT)
Community Response and Family
Training (CRAFT)
SBIRT has been demonstrated to detect substance abuse in PCSs;
adoption/addition of short screeners such as Bet-Lie (2-item) and Brief
Biosocial Gambling Screen (BBGS, 3-item) can detect risk behaviors. The
Centers for Disease Control conducts biannual surveys on youth risk
behavior, however no questions address gambling. [1] This hypothesizes a
missed opportunity as up to 73% of problem gamblers also present with co-
occurring substance use disorders including alcoholism or mental health
issues such as depression. [10]
CBT is a short-term EBI with demonstrated effectiveness in addiction,
including problem gambling. [9]
YPGs may benefit in particular from Community Response and Family
Training (CRAFT) intervention, which shows significant increase of IP
(identified patient) engagement at 64.4% over 12-step groups (13.6%) among
substance users. [5, 7, 8] Furthermore, relational dynamic of family/parent-
adolescent versus other (spousal) may bode favorably for outcomes as youth
gambler remains financially dependent on family unit (generally).
Research Longitudinal study
Excise or “sin” tax reinvestment
programs (e.g. tobacco) (after
evaluation and re-appropriation,
reinvestments to fund
prevention, education,
treatment, enforcement, and
further research)
Current literature cites research limited primarily to prevalence and
identification (e.g. type of gambling); literature suggests further need to
recognize YPG as potential new trajectory (with own etiology, preferred
interventions, and outcomes).
Reinvestment of tax revenues from tobacco are set and regulated at state
level; analysis shows subsidized treatment, education, and prevention of
substance use consequences of tobacco account on average for only 1.6% of
income, and are often first to be eliminated in periods of fiscal belt-
tightening. Subsidies more typically used for development of mass transit
(OH); wireless communication (IN); thoroughbred horse breeding and
cultivation industry (KY). Findings suggest opportunity to reevaluate. [2]
Rationale Reminder: Youth Doesn’t Wait!
Youth who gamble are at particular risk for developing addiction. Ongoing development of the limbic system and prefrontal
cortex (PFC) affect functioning of the adolescent brain’s reward system, impulsivity, judgment, and executive decision
making facility. Adolescents are highly susceptible to peer pressure and emotional regulation and response to family,
school, and social stress; they are exceptionally suggestible to “user experience” (UX) and place high value on spending on
“experience” over tangible goods. A high rate of technology literacy and connectivity set low barriers to gambling activity
[4]. Societal attitudes condone and glamorize gambling (e.g. gambling is a preferred alternative to taxation for generating
public revenue), and that problem gambling is often a “hidden addiction” for its lack of outwardly observable signs, make it
especially difficult to detect—and treat in time. [4]

3. REFERENCES
1 Agerwala, S. M., & McCance-Katz, E. F. (2012). Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice
settings: A brief review. Journal of Psychoactive Drugs, 44(4), 307–317.
2 Centers for Disease Control and Prevention. (2010, May 25). State tobacco revenues compared with tobacco control appropriations – United
States, 1998-2010. Morbidity and Mortality Weekly Report, 61(20), 370-374.
3 Friend, K. B., & Ladd, G. T. (2009). Youth gambling advertising: A review of the lessons learned from tobacco control. Drugs: Education,
Prevention and Policy, 16(4), 283-297.
4 Griffiths, M. D., Parke, J., & Derevensky, J. L. (2011). Remote gambling in adolescence. In J. L. Derevensky, D. T. L. Shek, & J. Merrick (Eds.),
Youth gambling: The hidden addiction (pp. 125-143). Berlin: DeGruyter.
5 Hodgins, D. C., Toncatto, T., Makarchuk, K., Skinner, W., & Vincent, S. (2007). Minimal treatment approaches for concerned significant others
of problem gamblers: A randomized controlled trial. Journal of Gambling Studies, 23, 215-230.
6 Marotta, J., Bahan, M., Reynolds, A., Vander Linden, M., & Whyte, K. (2014). 2013 National survey of problem gambling services: Executive
summary. Washington, DC: National Council on Problem Gambling.
7 Meyers, R. J., Roozen, H. G., & Smith, J. E. (2011). The community reinforcement approach: An update of the evidence. Alcohol Research and
Health, 33, 380-388.
8 Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three
strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67(5), 688-697.
9 Petry, N. M. (2009). Disordered gambling and its treatment. Cognitive and Behavioral Practice, 16, 457-467.
10 Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from
the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66: 564-574.
11 Rahman, A. S., Pilver, C. E., Desai, R. A., Steinberg, M. A., Rugle, L., Krishnan-Sarin, S., & Potenza, M. N. (2012). The relationship between age
of gambling onset and adolescent problematic gambling severity. Journal of Psychiatry Research, 46(5), 675-689.
12 Riordan, M. (2014, December 29). Public Education Campaigns Reduce Tobacco Use [press release]. Washington, DC: Campaign for Tobacco-
Free Kids.