2. You Bet Your Life: Gambling as an Addiction DASA Treatment Institute July 6-8, 2006 Linda Graves, MA, NCGC-II Problem Gambling Program Manager Division of Alcohol and Substance Abuse

3. DSM-IV Criteria Substance Dependence 303.90 A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: Tolerance, as defined by either of the following: –A need for markedly increased amounts of the substance to achieve intoxication or desired effect –Markedly diminished effect with continued use of the same amount of the substance. Withdrawal, as manifested by either of the following: –The characteristic withdrawal syndrome for the substance –The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

4. The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance DSM-IV Criteria Substance Dependence 303.90

5. DSM-IV criteria Pathological Gambling 312.31 A.PERSISTENT AND RECURRENT MALADAPTIVE GAMBLING BEHAVIOR AS INDICATED BY AT LEAST FIVE OF THE FOLLOWING: 1.Is preoccupied with gambling 2. Needs to gamble increasing amounts of money in order to achieve the desired excitement 3. Has repeated unsuccessful efforts to control, cut back, or stop gambling

6. 4.Is restless or irritable when attempting to cut down or stop gambling 5.Gambles as a way of escaping from problems or of relieving a dysphoric mood 6.After losing money gambling, often returns another day in order to get even 7. Lies to family members, therapist, or others to conceal the extent of involvement with gambling DSM-IV criteria Pathological Gambling 312.31

7. DSM-IV criteria Pathological Gambling 312.31 8.Has committed illegal acts, such as forgery, fraud, theft, or embezzlement, in order 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 B. THE GAMBLING BEHAVIOR IS NOT BETTER ACCOUNTED FOR BY A MANIC EPISODE.

8. ACTION GAMBLERS Often male Competitive Grandiose Low frustration tolerance

9. ACTION GAMBLERS Poor coping and intimacy skills Traditional use of Gambler’s Anonymous Use of the first step is important Importance of surrender theme

10. ACTION Gamblers Quantity theme, meeting size & length Abstinence is the beginning of a normal life Support from family and friends Improvement seen early

11. Escape Gamblers Often female Non-competitive Passive Often a victim of abuse

12. Poor assertiveness skills Poor coping skills Non-traditional use of Gambler’s Anonymous Use of other first step programs Women for sobriety)

13. Importance of empowerment model Quality theme, meeting intimacy, depth Abstinence=the loss of a best friend, safety Lack of support

14. No improvement early, and may in reality get more depressed Suicidal ideations

15. Lie/Bet Tool 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? Reference: Johnson, E.E., Hamer,R., Nora, R.M., Tan, B., Eistenstein, N., & Englehart, C. (1988). The lie/bet questionnaire for screening pathological gamblers. Psychological Reports, 80, 83-88. Administer Lie-Bet Screening Instrument “Yes” to one or both questions“No” to both questions Further assessment needed. Refer client to gambling treatment program. Call the Problem Gambling Helpline: 1-800-547-6133 No referral. Follow-up as necessary. Crime Financial problems Alcoholism Drug abuse Other mental health issues

16. Problem Gambling Treatment Provider Locations 1 2 3 5 7 4 9 10 1413 6 12 8 11

17. Confidential, 24/7, from any place.

18. Linda Graves 360-725-3813 gravell@dshs.wa.gov