2. Recognizing Problem Gambling Developed by Nicole Corbin, LPC, CADC I Presented by Richard Johnson, MA, CGAC II, CADC III, NCGC II Gambling Outreach/Prevention

3. Goals for presentation  Understand gambling in Oregon; prevalence among youth  Differences/similarities with substance abuse  Indicators and impact of problem gambling on youth and families  Assessment  Become familiar with resources to address problem gambling

4. Gambling in Oregon is Growing Spirit Mt. Casino has replaced Multnomah Falls as our #1 tourist attraction

5. Societal Acceptance = More Gamblers  Industry perpetuates a vision of gambling as entertaining, glamorous and as a means of achieving financial freedom.  Recent surge in reality TV gambling shows  High use of internet gaming sites among those under 18

6. Oregon Numbers  2002 Oregonians spent $1.18 billion on all forms of gambling, $447 per adult 25% more than the national average*  2003 Legislation made way for a 20% increase in Video Lottery Terminals  2004A ninth tribal casino opened in Oregon  2005The Lottery expanded into video slots  2006Lottery exceeds $1 billion in sales, video lottery sales up 24% over previous year Source: * Eco Northwest, 2005

7. Affected Oregonians  More than 74,000 Oregon adults (2.7% of all adults in the state) are believed to meet the criteria for being current problem or pathological gamblers (Moore, 2007)  1.3% of Oregon youth are problem gamblers, and an additional 4.6% are at-risk gamblers. That means there are between 1,100 and 6,300 adolescents with severe gambling-related difficulties (Volberg, 2007)

8. More Casinos?

9. Oregon Gambling: Summarized Oregon Gambling: Summarized Oregon has more forms of legalized gambling and offers easier access to gambling than almost any other state Oregon has more forms of legalized gambling and offers easier access to gambling than almost any other state - AND - - AND - Oregon is a nationally recognized leader in prevention, harm reduction and treatment for gambling problems Source: National Ctr for the Study of Gambling, 2006

10. What is Gambling? (G.A. Definition)  Any betting or wagering, for self or others whether for money or not, no matter how slight or insignificant, where the outcome is uncertain or depends upon chance or “skill” constitutes gambling.

11. What is Gambling? (A definition for clients)  Playing a game of chance or “skill” where money, or something of value, is placed at risk based on the uncertain outcome of a future event  Chance, Skill, Money, Risk, Uncertain Future?

12. What is Problem Gambling?  All patterns of gambling behavior that compromise, disrupt, or damage personal, family, educational or vocational pursuits  Pathological gambling is the most severe pattern of excessive or destructive gambling

13. Pathological gambling  Synonymous with “compulsive”, “addicted”, “clinical”, “diagnosable” and “Level 3”  Classified in DSM-IV as an Impulse Control Disorder  Diagnostic criteria is similar to that of Substance Abuse/Dependence

14. DSM-IV Diagnostic Criteria for Pathological Gambling  Persistent and recurrent maladaptive gambling behavior as indicated by five or more of the following: 1)Is preoccupied with gambling 2)Needs to gamble with increasing amounts of money in order to achieve the desired excitement 3)Has repeated unsuccessful efforts to control, cut down, or stop gambling 4)Is restless or irritable when attempting to cut down or stop gambling 5)Gambles as a way of escaping a problem or of relieving a dysphoric mood

15. DSM-IV Diagnostic Criteria for Pathological Gambling cont. 6) After losing money gambling, often returns another day to get even (“chasing” after one’s loses) 7) Lies to family members, therapist, or others to conceal the extent of involvement with gambling 8) Has committed illegal acts, such as forgery, fraud, theft, or embezzlement to finance gambling 9) Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling 10) Relies on others to provide money to relieve a desperate financial situation caused by gambling

16. Pathological Gambling: Comparison to Substance Abuse –Similarities  Loss of Control  Preoccupation  Negative impact on major life areas  Tolerance  Immediate gratification  Agent used as avoidance tool (e.g., pain)

17. Pathological Gambling: Comparison to Substance Abuse –Similarities  Withdrawal Symptoms  Self-help groups  Biopsychosocial/spiritual disorders  Family involvement  Use of rituals

18. Pathological Gambling: Comparison to Substance Abuse –Differences  Gambling is not self-limiting  Behavior not attributable to intoxication / chemical ingestion  More intense sense of shame and guilt  Greater denial and stronger defenses

19. Pathological Gambling: Comparison to Substance Abuse –Differences  Unpredictable outcome  Fantasies of success /quitting is giving up hope  No biological test  Easier to hide

20. Indicators of problem gambling Increase in gambling time and places Increase in gambling time and places Increase in size of bets Increase in size of bets Increase in intensity of interest in gambling Increase in intensity of interest in gambling Working up special occasions for gambling Working up special occasions for gambling Boasting about wins; not talking about losses Boasting about wins; not talking about losses Exaggerated display of money and other possessions Exaggerated display of money and other possessions With teens, increase in computer use With teens, increase in computer use

21. More Indicators Gambling when there is a crisis Gambling when there is a crisis Drop off in other activities/interests Drop off in other activities/interests Frequent absences from school, work and home Frequent absences from school, work and home Diversion of funds earmarked for other purposes Diversion of funds earmarked for other purposes Hidden Funds Hidden Funds Personality changes (irritability/hostility/moodiness) Personality changes (irritability/hostility/moodiness) Withdrawal from family Withdrawal from family Decline in school performance Decline in school performance New friends; isolation from old friends New friends; isolation from old friends Missing possessions (may have been pawned) Missing possessions (may have been pawned)

22. Costs of problem gambling  25 - 50 percent of spouses abused  10 to 17 percent of children neglected or abused  FY 07-08 of 2,012 receiving treatment in Oregon: average gambling debt was $22,000 (underestimated) combined debt from gambling over $37 million; 99 clients had debts of over $100,000 57% jeopardized or lost a significant relationship or job 21% committed illegal acts to obtain gambling money 28% had alcohol problems; 12% drug problems 21% reported suicidal thoughts and 7% reported having made an attempt

23. The More Problem Gamblers, the More Gambling Related Crimes  Moore & Marotta ( 2006). –43% of women and 38% of men entering gambling treatment reported to have committed an illegal act related to their gambling.  National Gambling Impact Study Commission (1999). –A third of problem and pathological gamblers had been arrested, compared to 10% of low-risk gamblers and 4% of non-gamblers

24. Samuel Hopkins, Pastor of First Congregational Church, Montpelier Vermont on April 19, 1835  “Let the gambler suffer this persecution. Lay upon him the biting lash of public odium. Let him be conscious that… he must bear the superadded curse of unrestrained abhorrence; that whatever else may be tolerated, there can be no tolerance and no c ourtesy for a vice so foul as his” (Hopkins 1835:15).  Stigma of PG remains today – a clinician needs to understand the social stigma that remains with this disorder. We are not far removed from Pastor Hopkins.

25. Co-occurring Disorders  Substance use disorders: About 30% of problem gamblers report a current substance use disorder at intake.  Mood disorders: About 50% of problem gamblers report significant depression symptoms at intake.  Suicide: About 10 percent of pathological gamblers report frequent suicidal ideation at intake.

26. Co-occurring Disorders (Continued)  Personality Disorders: Problem gamblers in the general population were over 6 times more likely to meet criteria for ASPD than non-gamblers. Youth have a higher incidence of ODD  Anxiety disorders: 12 - 28% of treatment seekers met criteria for an anxiety disorder.

27. Irrational Ideas about Gambling Held by Some Gamblers. 1. Gambling is an important human activity 2. Gambling is an easy way to earn money 3. Those who do not gamble are stupid, slow or frightened 4. Dedicated gamblers are usually bright and creative 5. Gambling is healthy recreation 6. My gambling is under control, or can be controlled with some effort 7. I do not have to quit; I can just cut down and ration my gambling 8. I can win it back 9. I’m smart; I have a system to beat the odds 10. People respect a heavy bettor

28. Irrational Ideas about Gambling Held by Some Gamblers. 11. Someday I’ll score a really big win and quit with honor 12. Gambling will be the solution to my problems 13. Expensive presents will make up for past disappointments 14. Gambling makes me feel better 15. Money is my problem 16. I will pay it back 17. Borrowing to gamble is okay 18. Stealing to gamble isn’t really stealing 19. The more money I have to gamble with the more I can win 20. Even if I only have a few bucks, I’m better off taking a shot at winning

29. Irrational Ideas about Gambling Held by Some Gamblers. 21. Somebody will be there to bail me out if things go really wrong 22. If only I knew why I gamble, I could stop 23. Will power is the answer 24. I always win in the long run 25. I’m just a lucky person when I win and really just unlucky when I lose 26. What’s the use, I can’t stop 27. Sometimes I think I am really two personalities, a gambler and a non-gambler 28. Suicide would solve all my gambling problems 29. I can’t afford to pay for treatment or take time off from work to get help

30. Irrational Ideas about Gambling Held by Some Gamblers. 30. I have to make as much money as I can as quickly as I can 31. I am luckier than most people. 32. Gambling is a good way to forget about my problems. 33.My gambling isn’t hurting anybody 34.Gambling will solve my family’s problems  [Adapted from “In the Shadow of Chance,” and Internet book by Julian I. Taber, 1998.]

31. Problem Gambling Screening Procedures  The Lie-Bet Questions: 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? If yes to one or both, further assessment is indicated

32. Screening techniques  Ask on intake about gambling –Also ask during collateral contacts  Assess financial issues in family  Ask “How often…” and “How much…”  Ask about Leisure and recreational interests  Ask if parents or siblings gamble

33. Gambling Treatment in Oregon  Oregon has 27 outpatient gambling treatment programs  3 crisis-respite programs  1 residential treatment program  Free Treatment for gamblers and family members

34. Problem Gambling Help Line: Free and confidential; staffed by professional counselors Phone: 1 (877) MY LIMIT (1-877-695-4648) 1(877)-2-STOP-NOW (1-877-278-6766) 1(877)-2-STOP-NOW (1-877-278-6766) Online: 1877mylimit.org (chat, IM, email)

35. Conclusions  Problem gambling is a real and growing concern  Affects about 1 in 37 adults and 1 in 45 youth  Help is available for gamblers and family members  81% of clients reported either no gambling or reduced gambling at 6-months post- treatment  Treatment is free, confidential and effective