April 26, 2016. Julie Hynes, PreventionLane at Lane County Public Health. Guest lecture for SAPP 407 - Understanding Addictions with George Baskerville.
ISYU TUNGKOL SA SEKSWLADIDA (ISSUE ABOUT SEXUALITY
Disordered Gambling: Understanding Addictions
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:
6. DEFINITION:
______ something of value
in the _________________
something of greater
value.
hopes of obtaining
RISKING
Source: American Psychiatric Association - DSM-5 (2013).
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?
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.
40.
41.
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
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
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.
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
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
70.
71. Watch the next few
slides & think about
what you are watching.
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?
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.
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
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.
98.
99. Creating conditions in families,
schools, and communities that
promote the wellbeing
of people
Emotional, Behavioral
& Physical health
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”
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.
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
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
Oregon Lottery 2009: $1.24 billion (Oregon Lottery, 2009)Oregonians spent $1.6 billion on all forms of gambling in 2007 (EcoNW, 2007)Lane County citizens spent an average of $330 per capita on lottery games in 2009 (Oregon Health Authority, 2010)About $7 out of every $10 was spent on video lottery games (video poker & slots)
Oregon Lottery 2009: $1.24 billion (Oregon Lottery, 2009)Oregonians spent $1.6 billion on all forms of gambling in 2007 (EcoNW, 2007)Lane County citizens spent an average of $330 per capita on lottery games in 2009 (Oregon Health Authority, 2010)About $7 out of every $10 was spent on video lottery games (video poker & slots)
Oregon: 9 tribal casinosEach tribe has one casinoDifferent rules in OregonTobacco: OKAlcohol: OK (2 casinos as of 2/10)
Superstition, rabbits feet, the number 13, black catsMost forms of luck, gambling, playing the lottery, slot machine feverThe evil eye, hexes, most black magic
Superstition, rabbits feet, the number 13, black catsMost forms of luck, gambling, playing the lottery, slot machine feverThe evil eye, hexes, most black magic
The physiological process of an addiction is demonstrated by looking at a brain of a gambler. The top image is the brain of someone gambling . . . the bottom image is of a cocaine user . . . notice how parts of the brain “light up” in anticipation of gambling, just like it does when it anticipates a drug.
These are data from the 2010 Lane County Student Wellness Survey, and asks students in the 6th, 8th, and 11th grades about how much they’ve done certain behaviors in the last 30 days.Gambling is the most common problem among 8th graders and alcohol use as the most prevalent problem among 11th graders. (Gambling involves betting anything of value, e.g. money, watch, etc. Types include: lottery, dice, betting on games, bingo)Alcohol is the substance most used among all ages (8%, 22%, 41%); aside from alcohol use, 8th grade substance use runs around 10% and 11th grade substance use generally in 20-30%. *Depression= ‘Did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?’
“Every 15 minutes” / Grim Reaper“Scared Straight”“Just say no”All may have a temporary influence, and are quite powerful…. But do not change behavior over time.
Of those enrolling, 87% report machine gambling as their primary choice and 74% report gambling at an Oregon retailer.Based on projections made by R. Volberg where approximately 3% of those with gambling problems should be expected to access treatment.
Successful completers = $3,224 per casehttp://www.problemgamblingprevention.org/docs/2011-Oregon-Problem-Gambling-Data-Book-Data-Brief.pdfUnless otherwise noted this data comes from the 2011 Gambling Programs Evaluation Update (T. Moore)