2012 NCA Conference, Keynote

1. What’s hidden in
those cards?
Inside the World of
Problem Gambling
Julie Hynes, MA, CPS
“Thinking Outside the Box”
NCA 2012 Conference

2. Our Evening “Out of the Box” –
what it isn’t
We aren’t going
to talk about
HOW to treat
gamblers

3. Our Evening
“Out of the Box”
What it is:
• Why problem gambling
deserves our attention
• Addiction & mental
health connections
• ID & referral
• Fun (Family Feud!)

4. $
 Opportunity

6. Gambling
To risk money or
something of value on
the outcome of an
unpredictable event.

7. Anything Can Be a Bet…
Image sources: sportsbet.com, bovada.com
Oddsshark.com, wagerminds.com

8. Betting on Brangelina
Image source: telegraph.co.uk
Odds: wagerminds.org

9. Image sources: Oregon Lottery, Hynes

10. Not Your
Uncle’s
Gambling

12. Available

16. It’s everywhere.

22. Gambling: A Continuum
No Recreational At-Risk Problem Pathological
Gambling Experimentation
Between 2-3% adults 18+ problem gamblers
Teens (13-17 y.o.): 6% at risk or problem gamblers 2
College age (18-24): 5.6% 3
Sources: 1. Moore (2006). 2. Volberg, Hedberg, & Moore (2008). 3. Shaffer & Hall (2001). 4. Northwest Survey & Data
Services (2007). 5. Moore (2001).

23. “Social/Recreational” or
Problem Gambler?
Recreational Problem
Gambler Gambler
Occasional Frequent, preoccupied
Sticks w/ limits Plays w/needed $, borrows
Hopes to win, expects to
Hopes & expects to WIN
lose
Can take it or leave it Primary source of “fun”

24. Definitions
PATHOLOGICAL:
Persistent and recurrent
maladaptive gambling
behavior...results in the
“PATHOLOGICAL LOSS OF CONTROL over
gambling. (DSM-IV)
GAMBLING” also called
“compulsive gambling” or
“gambling addiction”

25. Signs: Pathological
Gambling (DSM-IV-TR)
1. Preoccupation with 6. “Chases” losses
gambling 7. Lies to others to conceal
2. Increases amount of money gambling
gambled 8. Has committed illegal acts
3. Unsuccessfully tries to quit 9. Has jeopardized
4. Restless or irritable when relationships
trying to cut down/stop 10. Relies on others to bail
5. Gambles as an escape him/her out
*”Pathological” gambling = At least five of above, and not accounted for by a Manic Episode.
Pathological Gambling is defined in DSM-IV as an “Impulse Control Disorder”
Source: American Psychological Association (1994).

26. “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

27. The “Addiction” Connection
Similarities? Differences?
 Loss of control  Defining “use” (gambling)
 Denial  Behavior not attributable to
 Depression/mood swings chemical ingestion
 Progressive
 No biological test
 Tolerance
 Use as an escape  More intense sense of shame
 Preoccupation and guilt (anecdotal)
 Similar “highs”  Unpredictable outcome
 Self-help groups  Fantasies of success /quitting
 Family involvement is giving up hope
 Use of rituals  Easier to hide

28.  Debt - $30,000
 Crime – 25%
 Depression/suicide
 48% seriously considered suicide
 9% attempted suicide
 Relationship jeopardized/lost – 35%
 Concurrent alcohol problems – 34%
 Concurrent drug problems – 15%
Source: Oregon Health Authority, 2011

30. Phases of Problem Gambling
Winning
Losing
Hitting “Bottom”
 Desperation
 Crime
 Divorce
 Depression/Suicide
Desperation
 Getting help?
Source: Custer, R. (1980). “Custer Three Phase Model.”

31. Causes? (Risk Factors)
 Trauma -- stemming  Community norms/laws
from abuse or neglect
 Early initiation
 Mental health issues
 Friends favorable toward
 Substance use gambling
 Parental attitudes &
behavior
 Competitive family

32. Vulnerable Populations
• Older adults • Substance abuse
• College students history
• Ethnic minorities • Mental health
• Incarcerated persons history
• Military & veterans • Youth
• Women

34. In Perspective

35. Addiction is a “Developmental
Disease”- National institute on Drug Abuse
Prefrontal
Cortex

36. Potential Neurotransmitter
Roles in PG
Role in Impulse
Neurotransmitter
Control
Serotonin  Serotonin -- risk taking
Behavior Initiation/Cessation
Norepinephrine PGs -  NE levels
Arousal, Excitement
Opioids Gambling -  β-endorphin
Pleasure, Urges
Dopamine PGs -  dopamine response
Reward, Reinforcement
Dopamine: most studied neurotransmitter in problem gambling

37. Gambling & The “Doped” Brain
Decisions that will likely cause us to
lose money vs. win money
Source: Brain Briefings (2007, October), Society for Neuroscience, Washington, DC

39.  1 in 175  1 in 175 million
 1 in 175,000  1 in 175 billion

40. 1 in 175 Million
(174,233,510)
Odds of getting struck by lightning:
1 in 280,000

41. 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

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

43. How would you describe what
you see below?

44.  Magical
Thinking
 Superstition

45. Personalization

46. Selective
memory

47. Cognitive
Dissonance

48. Mental Health/Addictions Connections
 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)

49. Comparison of “Action” and
“Escape” Pathological Gamblers
Action Escape
Excitement, competition Relief, escape from stress
“Skilled” forms of gambling “Luck” forms of gambling
(sports/poker, etc) (lottery, slots, bingo)
Early onset of gambling Later onset of gambling
More likely to present More likely to present
narcissistic or antisocial traits depressive/dysthymic traits
Source: Center for Substance Abuse Treatment, 2005.

51. 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

52. •Amygdala active
• Fight or flight, emotion “The adolescent brain is
especially sensitive to the
• Decision-making effects of dopamine.
altered
•More vulnerable to risk-
taking & impulsive
behaviors
Source: Ramoski, S., Nystrom, R. (2007).

53. 2010 Oregon Student Wellness
Survey (Lane County)
Lane County Youth
Gambled Drank Alcohol Binge Drank Alcohol Smoked MJ Smoked Cigarettes
50
44.3
45 41.0
40
Percentage
34.5 33.7
35
30 27.2
25 22.6 21.8
20
14.1
15 11.9
8.5 9.1
10 6.9
5 1.4 2.4 2.1
0
6th 8th 11th
Grade
Data Source: Oregon Student Wellness Survey, 2010 Full report available at: http://preventionlane.org/sws.htm

54. Youth gambling and alcohol use
Used alcohol in the past month
100%
90%
80%
70%
60%
Percentage
50%
Did not gamble Gambled
40%
30%
20%
10%
0%
Grade 6 Grade 8 Grade 11

55. Youth gambling and binge drinking
Binge drank in past 30 days
50%
45%
40%
35%
30%
Percentage
25%
Did not gamble Gambled
20%
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11

56. Youth gambling and smoking
Smoked cigarettes in the past month
50%
45%
40%
35%
30%
Percentage
25%
Did not gamble Gambled
20%
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11

57. Youth gambling and marijuana
Used marijuana in the past month
50%
45%
40%
35%
30%
Percentage
25%
Did not gamble Gambled
20%
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11

58. Youth gambling and skipping
school
Skipped school one or more days in the past month
50%
45%
40%
35%
30%
Percentage
25%
Did not gamble Gambled
20%
15%
10%
5%
0%
Grade 6 Grade 8 Grade 11

59. Youth gambling and suicide attempts
Percent of youth who attempted suicide in the past
year
30%
25%
Percentage
20%
Did not gamble
15% 11.3%
9.0% Gambled
10% 7.2%
5.0%
5%
0%
Grade 8 Grade 11

60. Youth problem gambling and
suicide attempts
Percent of youth that attempted suicide in the past
year
30%
25% 21.0% Did not
18.6% bet/gamble
Percentage
20%
more than
15% wanted to
10.1%
10% 8.0%
Bet/gambled
5% more than
wanted to
0%
Grade 8 Grade 11

61. Conclusion:
Teens who gamble are
smoked up, toked up,
drunk emo delinquents.

62. Conclusion:
Teens who gamble are
smoked up, toked up,
drunk emo delinquents.

63. Problem Gambling is
ONE COMPONENT of Problem
Behaviors
sexual
behavior
delinquency
Problem
smoking
Behaviors
gambling
drug
use

64. identification &
treatment

65. University of Oregon Survey
2010
A majority of students (62%) thought
problems with gambling could be
changed through ‘will power.’
At the same time, an even larger
majority (87%) agreed that gambling is
an addiction similar to a drug
or alcohol addiction.

66. Intervention
• Intake/Assessment
• Referral to provider for
assessment
• Family members in

67. The “Lie-Bet” Screening Tool
(Johnson et al., 1988)
preventionlane.org/gambling/lie-bet.htm
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

68. Assessment Tools
• “Valid and Reliable”
– DSM-IV 10
– South Oaks Gambling Screen (SOGS)
– SOGS-RA (Revised for Adolescents)
• Frequently Used
– Gamblers Anonymous 20 Questions (GA-20)

69. DSM-IV-TR Criteria Revisited
1. Preoccupation with 6. “Chases” losses
gambling
7. Lies to others to conceal
2. Increases amount of gambling
money gambled
8. Has committed illegal
3. Unsuccessfully tries to
quit acts
4. Restless or irritable 9. Has jeopardized
when trying to cut relationships
down/stop 10. Relies on others to bail
5. Gambles as an escape him/her out
Pathological Gambling =
Five or more of above, AND: The gambling behavior is not better
accounted for by a Manic Episode.

70. Treatment
Nebraska DHHS Gamblers Assistance Program:
• http://dhhs.ne.gov/behavioral_health/Doc
uments/GAP-FY12-13ProviderManual.pdf
Nebraska Council on Compulsive Gambling
• www.nebraskacouncil.com

71. Treatment is Effective
and Inexpensive
• $3,224: Cost per
successful
completer
• 86%: Report no,
or far reduced,
gambling
Source: Moore, T. 2011 Gambling Programs Evaluation Update.

72. Thank you! For more Info…
Julie Hynes, MA, CPS
Lane County Public Health Prevention
Program
541.682.3928 | julie.hynes@co.lane.or.us
preventionlane.org
problemgamblingprevention.org

73. References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed., text revision). Washington, DC: Author.
Cross, Del Carmen Lorenzo, & Fuentes (1999). The extent and nature of gambling among college
student athletes. Ann Arbor, MI: University of Michigan Department of Athletics.
Department of Defense (2002). Survey of health related behaviors among military personnel
Washington, DC: Author. Report information available
http://www.tricare.mil/main/news/dodsurvey.htm
DiClemente, C. (2003). Addiction and change: How addictions develop and addicted people
recover. New York: Guilford Press.
ECONorthwest (2009). The contributions of Indian gaming to Oregon’s economy.
http://www.econw.com/reports/2009_ECONorthwest_Contributions-Indian-Gaming-Oregon-
Economy-2007.pdf
Engwall, Hunter & Steinberg (2004). Gambling and other risk behaviors on university campuses.
Journal of American College Health. 52 (6); 245-255.
Freimuth, M. (2008). Addicted? Recognizing Destructive Behavior Before It's Too Late
. Maryland: Rowman & Littlefield Publishers.
Kerber (2005). Problem and pathological gambling among college athletes. Annual of Clinical
Psychiatry. 17 (4); 243-7.
LaBrie, R., Shaffer, H., LaPlante, D., and Wechslet, H. (2003). Correlates of college student
gambling in United States. Journal of American College Health. 52 (2); 53-62.
Moore , T.L. (2002.) The etiology of pathological gambling. Salem, OR: Department of Human
Services. http://www.oregoncpg.com

74. References
Moore, TL. (2006). Oregon gambling prevalence replication study. Salem, OR:
Department of Human Services. http://www.oregoncpg.com
Moore (2001). Older adult gambling in Oregon. Salem, OR: Department of Human
Services. http://www.oregoncpg.com
Northwest Survey & Data Services (2007). Lane County Health & Human Services
college gambling survey. http://www.preventionlane.org/gambling/college.htm
Oregon Health Authority, Problem Gambling Services (2011). Oregon problem
gambling awareness community resource guide. Salem, OR: Author.
Oregon Lottery (2009). Oregon State Lottery Behavior and Attitude Tracking Study.
November 2008. InfoTek Research Group, Inc.
Oregon Lottery (2008). Overview through fiscal year 2009. Salem, OR: Author.
Ramoski, S., Nystrom, R. (2007). The changing adolescent brain. Northwest Public
Health. http://www.nwpublichealth.org/archives/s2007/adolescent-brain
Rockey, D.L., Beason, K.R., & Gilbert, J.D. (2002). Gambling by college athletes: An
association between problem gambling and athletes.
http://www.camh.net/egambling/archive/pdf/EJGI-issue7/EJGI-issue7-research-
rockey.pdf
Shaffer, H.J., Donato, Labrie, Kidman, & LaPlante. (2005). The epidemiology of
college alcohol and gambling policies. Harm Reduction Journal. 2 (1).
Shaffer, H.J. & Hall, M.N. (2001). Updating and refining meta-analytic prevalence
estimates of disordered gambling behavior in the United States and Canada. Canadian
Journal of Public Health, 92(3), 168-172.
Volberg, R.A., Hedberg, E.C., & Moore, T.L. (2008). Adolescent Gambling in Oregon.
Northhampton, MA: Gemini Research. http://gamblingaddiction.org