1. ©2008 The GPPC Initiative1 Pathological Gambling An “Invisible” Addiction

2. ©2008 The GPPC Initiative2 Treatment Issues Generally the same, particularly with other co-occurring disorders: –Assess –Diagnose –Plan/Initiate Treatment –Evaluate the effectiveness of method

3. ©2008 The GPPC Initiative3 Pathological Gambling Largely “Invisible” Largely ignored / overlooked / tolerated until some precipitating crisis Personal calamity with collateral damage High Incidence of Co-Occurring Disorders High vulnerability at outer edges of the age spectrum (i.e., Teens and Elders)

4. ©2008 The GPPC Initiative4 Behavioral Addiction Deflection / Displacement Sub-optimal Stimulation The gambler becomes emotionally unavailable to family, friends, and associates

5. ©2008 The GPPC Initiative5 Diagnostic Spectrum Spectrum –Low Risk –At Risk –Problem Gambling –Pathological Gambling

6. ©2008 The GPPC Initiative6 Types of Gamblers Casual Social Serious Social Relief & Escape Compulsive (Problem, Pathological) Professional Anti-social Personality adapted from SAMHSA, 2005

7. ©2008 The GPPC Initiative7 Risk Factors Age at onset of gambling Gender Ethnicity Access Co-occurring disorders Family history Biochemical imbalance

8. ©2008 The GPPC Initiative8 Direct Risk Factors Risk Practices Risk Cognitions Risk level can increase based on: –Number of risk practices and cognitions –The extent of involvement in each

9. ©2008 The GPPC Initiative9 Thinking Errors (adapted from Ciarrocchi, 2001) Negative Winning Expectancy Independence of Turns Illusion of Control Superstition Recuperating Losses The “Near-Miss”

10. ©2008 The GPPC Initiative10 Indirect Risks Social Predisposition Emotional Predisposition Biological Predisposition Environmental Conditions

11. ©2008 The GPPC Initiative11 Health Problems Hypertension / Angina Heart Attack / Stroke Obesity Alcoholism / Cirrhosis Tobacco use

12. ©2008 The GPPC Initiative12 Co-Morbidity Mood Disorders Substance Abuse (e.g.,“MethGamblers”) Anxiety Disorders Personality Disorders ADHD High Risk of Suicidality

13. ©2008 The GPPC Initiative13 Prevalence / Incidence 85% of Americans report having gambled at least once 60% report having gambled within the last year More men than women More young people than seniors More African-Americans than other ethnic groups

14. ©2008 The GPPC Initiative14 Compulsive Gambling affects up to 6 Million Americans

15. ©2008 The GPPC Initiative15 Nevada vs. The World 6.5% General U.S. Population “At Risk” –NV = 9.9% 2.5% General U.S. Population “Problem” –NV = 6.4%

16. ©2008 The GPPC Initiative16 So What’s the Problem?

17. ©2008 The GPPC Initiative17 Addiction as a Maladaptive Behavior Addiction is a learned behavior Most appropriate treatment approach is to teach skills to prevent relapse Cognitive-Behavioral approach can work

18. ©2008 The GPPC Initiative18 Gambling (Gaming) 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” Gamblers Anonymous

19. ©2008 The GPPC Initiative19 Substance Abuse Antisocial Behavior School/Work Problems Problem Gambling Psychological Problems Poor Health Practices Interpersonal Problems Gambling is part of an inter-related set of high risk/problem behaviors (adapted from Williams & Connolly, 2003)

20. ©2008 The GPPC Initiative20 Self-Controlled  Impulsive Risk aversive  Risk seeking Stress resilient  Stress vulnerable Strong intellect/skills  Weak intellect/skills Caused by a common set of factors (adapted from Williams & Connolly, 2003) Abusive/neglectful  Nurturing/disciplined upbringing upbringing Antisocial parental  Prosocial parental modelling modelling Deviant peer group  Prosocial peer group Poor schools/  Good schools/ teachers teachers Biological Environmental

21. ©2008 The GPPC Initiative21 Decisional Balance for Addictions If one’s use / behavior creates more problems than it relieves, seek assistance