April 26, 2016. Julie Hynes, PreventionLane at Lane County Public Health. Guest lecture for SAPP 407 - Understanding Addictions with George Baskerville.

1. Julie Hynes, Sr. Community Health Analyst
Lane County Public Health,
National Council on Problem Gambling
SAPP 407 | University of Oregon | 4/26/16
GAMBLING

2. THIS AFTERNOON:
• History & trends
• Defining gambling disorders
• Addiction & mental health connections
• Gambling & the brain
• Addressing the issue
These slides are at:

3. POTENTIAL

6. DEFINITION:
______ something of value
in the _________________
something of greater
value.
hopes of obtaining
RISKING
Source: American Psychiatric Association - DSM-5 (2013).

7. A long
history

8. Image sources: Oregon Lottery, Hynes

9. Image sources: Oregon Lottery, Hynes

10. 2,400
retailers
in Oregon
ELECTRONIC GAMBLING:
“Video Poker/Slots/Line Games”
Data source: Oregon LotteryPhoto: Daniel Berman.

11. $8.60
out of
every $10
Lottery
dollarsPhoto: Daniel Berman.
ELECTRONIC GAMBLING:
“Video Poker/Slots/Line Games”
Data source: Oregon Lottery

13. Center photo: Daniel Berman.
Our changing world.
• Technology
• Speed
• Platform
13

15. 15

16. 16

17. Reasons for
Play
Theme/Genre
Rewards &
Reinforcements
Dopamine
Platforms
17

20. FANTASY SPORTS.
20

21. http://www.huffingtonpost.com/peter-v-emerson/fantasies-about-
fantasy-s_b_9183680.html

23. 23

24. 24

26. 1 in 175
1 in 175,000
1 in 175 million
1 in 175 billion

27. 1 in 175 Million
(175,233,510)
Odds of getting struck by lightning:
1 in 280,000

28. 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

29. So…if your lucky numbers
have “almost” come up in the
last 5 drawings, are your
chances better, worse, or the
same?

30. Sports bets
Lottery tickets
Video & online
Bingo & raffles

31. Videolottery
& onlinegambling
Electronic
Gambling
89% Cards
6%
Other
5%
Gambling Treatment Clients
Gamblers' Preferences

32. 0.1%
11.2%
1.2%
2.7%
Research shows about what
percentage of Oregon
adults have a gambling
problem?

33. 2.7% of Oregon adults
(1 in 37 people)
have a gambling problem.

34. “Last Week Tonight with John Oliver” –
11/9/14
https://www.youtube.com/watch?v=9PK-
netuhHA

35. disordered

36. PATHOLOGICAL:
Persistent and recurrent
maladaptive gambling
behavior...results in the LOSS
OF CONTROL over
gambling. (DSM-IV)
Definitions

37. Newlanguage

38. It’s a“Continuum”
No
Gambling Experimentation
Recreational Problem Pathological
Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data Services
(2007). 5. Moore (2001).
At-Risk
“GAMBLING DISORDER”
2.7% of the adult population in OR
(1 in every 37 Oregonians)

39. 5.6% college age (18-24)
2½ % all adults (18+)
4% teens (13-17)
This is the first
generation of
widely available
electronic
gambling.
We really don’t
know the effects
yet.

42. The new DSM-5 (May 2013) defines
pathological gambling as a
“behavioral addiction,”
the first of its kind.

43. Can you think of any other
behavioral issues that you think
should be classified as addictions?
Which ones?
What are arguments for/against
issues being called “addictions?”

44. 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

45. Source: http://www.oregon.gov/oha/amh/gambling/gear-workbook.pdf
THOUGHTS, FEELINGS,
ANTICIPATION,
FANTASY
(Gambler’s Mind,
“Gambling Time/
Gambling Money”)
PLANNING
(Removing obstacles
to gambling)
GAMBLING
(“Winning & Losing”)
Serotonin
Adrenaline
Dopamine
CRASH
Guilt, Shame, Anger, Denial,
Justification, Restless, Irritable,
Depression, Panic or Numb,
Suicidal Thoughts Dopamine
REALITY
(Self with Others)
“Real Time, Real Money”

46. 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

47. Source:
http://www.oregonlive.com/politi
cs/index.ssf/2015/04/oregon_lot
tery_amid_difficult.html

48. >70%
are current
tobacco users
24%
have current
alcohol problems
5%
actually attempt
suicide
Source: Oregon Health Authority, 2014
27%
experience
suicidal ideation
Use illicit drugs

49. AND IT’S NOT A
SOLITARY PROBLEM.
Each problem gambler affects an
average of 6-12 others.

51. Other
addiction
issues
Starting early
in life
Parental
attitudes &
behaviors
Community
laws &
norms
Mental health
issues
51

53. AVAILABILITY.

54. Amygdala
active
Risk-taking
& impulsivity
Source: Ramoski, S., Nystrom, R. (2007). Image source: simpsons.wikia.org
age…

55. Acceptability.

56. Advertising.

57. Pop-up on my kid’s game

58. 2012 Oregon Student Wellness Survey, Lane County (“ESD”) and Oregon;
available at http://oregon.pridesurveys.com/esds.php?year=2012
Awareness (low).

59. ATTITUDES.
Oregon parent/youth focus groups revealed:
All parents’ focus group said their kids didn’t
gamble
All of their kids, in their own focus groups,
said they did gamble
Neither sees gambling as risky

60. Typical Phases of
Problem Gambling
Source: Custer, R. & Rosenthal, M.
WINNING
LOSING
DESPERATION
HOPELESSNESS

62. Source: Oregon Health Authority, 2015

63. PROCESS of ADDICTION.

64. Typical Phases
of Problem Gambling
Source: Custer, R. & Rosenthal, M.
WINNING
LOSING
DESPERATION
HOPELESSNESS

65. Winning PHASE
 Early “big win”
 Excitement
 Feeling on top of the world
 Gambling is main entertainment
Image attribution: C-3PO: https://titoupaul.files.wordpress.com
Yes! I am a
winner.

66. Losing PHASE
 Large losses
 Using credit
 Borrowing money
 Arguing
 Missing school
or work
I’ll get my
money back in
no time.
My big win is
just around the
corner!

67. Desperation PHASE
 Obsessed with next win/game
 Lying
 Depressed
I sold my arm
but still short
of cash. Maybe
I can ask han
solo for a
loan.

68. Hopelessness PHASE
 Major lifeconsequences
 Winning no longer a goal; staying in “action”
is the goal
 Lost relationships, isolation
 Considering suicide
 Hitting “bottom”

69. These comparisons are of course
generalizations & do not by any means
reflect all male & female gamblers.
Comparison byStart gambling at older age
than men
Get addicted faster
Games of choice: video slots
More likely to be “escape”
gamblers
Start gambling younger
Tend to like games of
strategy & “action”
(poker, sports bets)
Less likely to
seek help
Images: disney.wikia.com

71. Watch the next few
slides & think about
what you are watching.

81. What Comes Next?

82. For good or bad, we are wired to see
patterns in things.
This can be “gambler’s fallacy” in the sense of a
cognitive distortion.
THIS was supposed to be “next.”

83.  18
 25
 21
 16
At what age is the
brain considered
fully developed?

84. The PREFRONTAL
CORTEX is the
LAST PART to
develop.
The brain
is still
developing
until

85. Neurotransmitter
Serotonin
Norepinephrine
Opioids
Dopamine
Role in Relation to
Gambling
Behavior Initiation/Cessation
Arousal, Excitement
Pleasure, Urges
Reward, Reinforcement
Dopamine: most studied neurotransmitter in problem gambling
 Serotonin --  risk taking
Gambling -   β-endorphin
PGs -   NE levels
PGs -   dopamine response
Neurotransmitter
“PGs” = problem gamblers | Neurotransmitters are brain chemicals that transmit
nerve impulses. Dopamine is known as the brain’s “reward system.”

86. Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC
Gambling & Dopamine
Dopamine not released when expecting a loss.
Flooded with dopamine when expecting a win!
It’s not about the money – it’s about the action of the game and the hope of
winning.

87. It’s about the action!
THE CONNECTIONS
MAKE SENSE.
“ALMOST
WINNING”:
dopamine is
activated the
same as
ACTUALLY
winning.
Problem
gamblers are
more likely to
see their near
misses as
“NEAR WINS”
People play
LONGER
when
machines
give them
NEAR
MISSES.
87

88. Sources: Tonneato, T. (1999). Cognitive psychopathology of problem gambling. Subst Use Misuse. Sep;34(11):159
Anecdotal reports from problem gamblers in treatment and recovery.

89. Image source: Anheuser-Busch
COGNITIVE Distortions
Lucky #’s
Favorite shirt
“My” machine
Superstition
Rituals/habits that
are believed
to affect the outcome.

90. COGNITIVE Distortions
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.”
Biased Evaluation
Attributing wins to one’s special
skill or luck, while losses are
blamed on external circumstances.

91. Image source: Anheuser-Busch
COGNITIVE Distortions
Forgetting about losses, only
remembering wins.
Selective Memory

92. COGNITIVE Distortions
Failure to see each event as independent.
Examples:
• Trying to see patterns in coin flips.
• “This slot machine is DUE to hit!”
Gambler’s Fallacy

93. Reflect: cognitive distortion
Have you ever
experienced a
cognitive distortion?
What was the
experience like?

95. addressing
the issue

96. It often takes
yearsfor someone
to
1) admit they have a problem
2) seek help, and then
3) continue in recovery

97. Check out the following chart
to see some of the steps from problem
gambling to recovery…
Like other addictions, some people relapse and
may need help several times before maintaining
recovery.

99. Creating conditions in families,
schools, and communities that
promote the wellbeing
of people
Emotional, Behavioral
& Physical health

100. contribute

101. Addressing the “A’s”

102. IS IT “SOCIAL” OR PROBLEM GAMBLING?
Social Gambler
Occasional
Sticks w/ limits
Hopes to win, expects to lose
Can take it or leave it
Problem Gambler
Frequent, preoccupied
Plays w/needed $, borrows
Hopes & expects to WIN
Primary source of “fun”

104. Intervention
Helpline
emergence
24/7:
1.877.MY.LIMIT
Referred to provider for
assessment
Family members come in;
later bring gambler in

105. Diagnosis (revisited)
1. Preoccupation with
gambling
2. Increases amount of money
gambled
3. Unsuccessfully tries to
quit
4. Restless or irritable when
trying to cut down/stop
5. Gambles as an escape
6. “Chases” losses
7. Lies to others to conceal
gambling
8. Has jeopardized
relationships
9. 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.

106. TREATMENT IS FREE.
24 hrs: 1877-my-limit
Online: 1877mylimit.org

107. Minimal intervention: GEAR
(Gambling Education and
Reduction)
Outpatient treatment
Crisis respite
Residential treatment
TREATMENT OPTIONS IN OREGON

108. Source: Oregonian,2/16/16:
http://www.oregonlive.com/portland/index.ssf/2016/
ttery_participation_rises.html

109. EMERGENCE GAMBLING
TREATMENT PROGRAM
Treatment free for gamblers and loved ones
- >200 problem gamblers and family members treated last
year
- Gender-specific
Multimodal treatment
- Individual sessions - Family therapy
- Group sessions - Recreational counseling
- Didactic lectures - Audiovisual educ.
Suggest to explore 12-step program as additional help

110. MANAGING TRIGGERS.
Lots of things can be triggers, but these are some key triggers.
People at risk should especially avoid gambling when:
H
A
L
T
ungry
ngry
onely
ired

111. OTHER TRIGGERS

112. Even just
driving down
the street
can be a
trigger.
https://www.flickr.com/photos/drbethsnow/5
995618252/in/photostream/

113. ON THE
RIGHT PATH

114. SUMMARIZING today:
• We defined gambling and looked at new
trends
• We defined when gaming/gambling
becomes a problem
• We saw the effects on the brain through
cognitive distortions & dopamine
• We looked at ways were are addressing
problem gambling

115. Last chance!

116. Under $100
$100-$1,000
$1,000-$2,500
More than $2,500

117. Problem gambling treatment is
‘free’ in Oregon for gamblers
AND loved ones.

118. The average problem
gambler in Oregon
gambling treatment owes
$4,000 in
gambling-related debts.

119. The average problem gambler in
Oregon gambling treatment owes
$30,000 in
gambling-related debts.

120. preventionlane.org
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