1. Gambling and Youth Gambling Issues Presentation to Value Options EAP Professionals July 24, 2008 Keith Whyte, Executive Director National Council on Problem Gambling

2. About NCPG The national advocate for people affected by problem gambling.  NEUTRAL on legalized gambling.  Founded in 1972.  National grassroots non-profit with chapters in 36 of 50 states.  Work with government, gaming industry & community.

3. Core Programs  National Helpline Network (800.522.4700)  Nat’l Problem Gambling Awareness Week  Annual Conference on Problem Gambling Prevention, Treatment, Research & Recovery (June 25-27, 2009, Indianapolis)  Public Awareness & Media  Certification Administration  ADVOCACY!

4. Key Issues and Trends In:  Gambling Today—Scope, Participation & Revenue  Problem Gambling—Definitions, Prevalence, Risk Factors, Co-Occurring Disorders & Service Delivery  Focus on Youth Gambling

5. Section I: Gambling Scope, Participation & Revenue

6. What Is Gambling?  Gambling is risking something of value on an uncertain outcome.  One of the oldest human behaviors, indeed, an apt description for most human activity.  3 Prong Test: Prize, Chance, Consideration  In the US, gambling is generally illegal unless a specific form has been specifically legalized by government.  Legal in 48 states—what are the 2 without? Utah Utah Hawaii Hawaii

7. Are We a Nation of Gamblers?  Ever Gambled? 85%  Gambled in the Past Year? 65%  Gambled at least weekly? 15%  But 35% of Americans believe that “gambling is morally wrong!”  18 th century moral mindset & laws v. 21 st century entertainment & technology

8. Adult (18+) Risky Behaviors: Smoking, Gambling & Drinking Past year Lifetime Tobacco Use 35%71% Alcohol Use 64%82% Gambling65%85%

9. 2006 Gaming NM & US NMUS NM Rev US Rev Casinos21839 $238 million $47.8 billion Racing5123 $36.8 million $4.5 billion Lottery137 $73.4 million $25.1 billion Charitable?? $12 million $1.5 billion TOTAL28999 $360 million $79 billion

10. Legal Gambling Revenue ($billions)

11. Trends & Issues:  Convergence of types of gambling.  Games become faster, more interactive, higher limits.  When will gaming participation and revenues peak? Is there a saturation point?  Will states and tribes continue to expand gambling?

12. Section II: Problem Gambling Definitions, Prevalence, Risk Factors, Co-Occurring Disorders & Service Delivery

13. Working Definitions  Problem gambling: “Any gambling behavior that causes harm to the gambler or their family.” Gambler does NOT meet current clinical criteria. Gambler does NOT meet current clinical criteria.  Pathological gambling: “Severe and persistent problems with gambling behavior, a serious mental health disorder.” Gambler meets clinical criteria. Gambler meets clinical criteria.

14. Screening Tools  NODS (NORC Diagnostic Screen)  CPGI (Canadian Problem Gambling Index)  SOGS (South Oaks Gambling Screen)  GA 20 (Gamblers Anonymous 20 Questions)  Lie/Bet Screen

15. 10 Questions DSM IV  You have often gambled longer than you had planned.  You have often gambled until your last dollar was gone.  Thoughts of gambling have caused you to lose sleep.  You have used your income or savings to gamble while letting bills go unpaid.

16.  You have made repeated, unsuccessful attempts to stop gambling.  You have broken the law or considered breaking the law to finance your gambling.  You have borrowed money to finance your gambling.  You have felt depressed or suicidal because of your gambling losses.  You have been remorseful after gambling.  You have gambled to get money to meet your financial obligations.

17.  If you or someone you know answers yes to any of these questions, consider seeking assistance from a professional regarding this gambling behavior.  Call 800.522.4700: Confidential & toll free, 24/7-there is help and hope available. Questions developed by NCPG from DSM- IV criteria. Probable pathological gamblers score 5+. Probable problem gamblers score 1-4. Questions developed by NCPG from DSM- IV criteria. Probable pathological gamblers score 5+. Probable problem gamblers score 1-4.

18. Lie/Bet Screen  Have you ever felt the need to bet more and more money?  Have you ever had to lie to people important to you about how much you gambled?  Yes to one or both classifies respondent as a pathological gambler Johnson, et al, (1997) Psychological Reports Johnson, et al, (1997) Psychological Reports

19. Problem Gambling Rates  In the past year, approximately 1% of adults (3 million) meet criteria for pathological gambling.  Past year, approximately 2-3% (6 to 9 million) adults meet criteria for problem gambling.

20. Prevalence Issues  States with stable or decreased rates had relatively larger PG programs.  Gaming revenue, type of gambling, # of EGMs, proximity to venue, etc…likely important but relationship unclear.  No significant regional differences.

21. Bio-Psycho-Social Risk Factors  Male  Athlete  18-24 Yrs  Substance use  Substance abuse  Other MH problem  Family history of addiction  Low SES  Military Service  Racial/Ethnic minority  Gamble illegally  Early onset  Early big win  Easy access to gambling

22. Biological/Environmental Factors Self controlled Impulsive Risk aversiveProne to take risks Predisposed toNo genetic MH MH problemspredisposition Abusive upbringing Nurturing Poor schoolsGood schools Poor social supportGood support Available gamblingRestricted games Severe stressAbsence of stress Poor coping skillsGood coping

23. Subtypes Action  More likely to be male  Prefer “skill” games  Narcissistic  Uses gambling to elevate mood Escape  More likely to be female  Prefer “continuous” games  Uses gambling to withdraw “zone out”

24. Co-Occurring Disorders Among PGs  35-60% of PGs lifetime criteria for SA. Alcohol: PGs average 4x higher lifetime abuse rate than non-gamblers. Alcohol: PGs average 4x higher lifetime abuse rate than non-gamblers. Drugs: PGs average 30% lifetime abuse/dependence (6% gen. pop.) Drugs: PGs average 30% lifetime abuse/dependence (6% gen. pop.) Tobacco: PGs average 55% lifetime dependence. Tobacco: PGs average 55% lifetime dependence.  SA associated with greater severity of PG.

25. PG in SA Populations  Tx Seeking SA have 2-10x rate of PG than general population.  Dual diagnosis (SA & PG) have more severe consequences (legal, social, family)  DD have more severe psychiatric symptoms (ADD, ADHD, ASPD)

26. Prevalence of MH Disorders Gen Pop PGs Tx Seeking PGs Any Disorder 8%40%60% Maj. Depression 5%20%60% Bipolar1.5%10%15% Suicidality5%20%50%

27. Warning Signs  Preoccupation with gambling  Inability to set a limit/stick to it  Borrowing from co-workers/friends  Unexplained financial difficulties  Substance abuse/mental health problems  Suggestions by others the employee may have a gambling problem  Mood swings due to winning and losing streaks

28. More Warning Signs Henry Lesieur, Ph.D. observed the following workplace behaviors as being correlated with a gambling addiction:  Excessive use of telephones (to call bookmakers or obtain credit)  Taking the company vehicle to the casino, etc. (parking tickets near gambling locations are a "red flag”)  Arriving late (related to all-night card games, anxiety- related sleep disturbances)  Failure to take days off (obsessed with getting money to pay gambling debts or afraid to leave because embezzlement or fraud may be discovered in their absence)  Organizing office pools and gambling junkets  Embezzlement, defrauding customers

29. Workplace Gambling  19% of all workers (but 1/3 of professionals, business & financial services workers) participated in March Madness pool, 24% paid more than $10 to enter (CareerBuilder.com, 2008)  66% of callers to an EAP program indicated employees gamble in their workplace, 46% said it negatively impacts productivity (hr.blr.com, 2006).  Casino employees have higher rates of gambling problems, smoking, alcohol use & depression (Am J Ind Med, 1999)

30. Social Cost  Losses to individuals.  Problem gamblers generate costs for society—crime, bankruptcy, divorce, etc...  U.S. National Gambling Impact Study Commission (1999): $1,200 per adult pathological gambler. $1,200 per adult pathological gambler. $715 per adult problem gambler. $715 per adult problem gambler.  2008 U.S. Estimate: $6.7 billion

31. Treatment Works, If Available  Only about 1% of current pathological gamblers seek treatment in a given year nationwide v. 20% of substance abusers.  States with well funded PG programs have much higher rates of treatment seeking (4% in OR, 4-10% in IA)  IA: 61% abstinent at followup.  OR: 63% not gambled for at least 6 mos at 1 year followup.

32. Counseling  Several national specialty certifications.  General state & national MH/SA certifications do not include problem gambling training.  Not routinely reimbursed by state or private insurance (54% have coverage, but only 9% used it).

33. Life Skills & Help for Families  Prevention programs  Financial guides  Conflict between GA pressure relief & credit counseling  Some treatment programs include family therapy.  Spouses can be liable for unpaid taxes on gambling winnings.

34. PG Specific Residential/Inpatient  10 centers (incl. VA) Less than 100 beds for 3 million pathological gamblers.  Who is payor of last resort?  VA 1 Year followup: 55% abstinent for 1 year + 27% abstinent at least 1 month

35. Services Implications  Tx for PG may be less expensive than substance abuse (no medical detox)  Majority seem to be effectively treated in outpatient settings.  Public/private partnerships are the dominant method of service delivery.

36.  National Problem Gambling Awareness Week  March 2-8, 2009 www.npgaw.org  50+ free materials Screening tools Screening tools Posters Posters Flyers Flyers Brochures Brochures Press releases Press releases Stories Stories

37. Section III: Youth Gambling

38. Kids Today…  Increasing Majority of Youth Gamble (approximately 70% in past year, average prior to 1988 was 45%, between 1988 and 1999 65%)  First generation of kids to grow up with: unprecedented levels of legalized gambling (in 1976 less than a dozen states allowed gambling—48 plus more than 250 tribes today); unprecedented levels of legalized gambling (in 1976 less than a dozen states allowed gambling—48 plus more than 250 tribes today); pervasive promotion (state lotteries alone spent $400 million on advertising in 1999); pervasive promotion (state lotteries alone spent $400 million on advertising in 1999); high rates of implicit parental endorsement (over 50% gamble with family members, 78% gamble in own homes) high rates of implicit parental endorsement (over 50% gamble with family members, 78% gamble in own homes)

39. Past Year Prevalence of Gambling

40. Gambling Participation (14-17)

41. Gateway?  May be the “gateway” activity as age of onset for gambling is earlier than all other risky behavior.  Youth who gamble have higher rates of substance use, drunk driving, delinquency, sexual behavior and other antisocial behavior.  Maybe it is because kids become accustomed to and enjoy risk taking learned in gambling?

42. Youth Problem Gambling  Approximately 4-6% of youth (< 17) meet criteria for a gambling problem.  Risk factors include: male, low SES, other risk taking behavior, racial/ethnic minority.  Extremely low rate of awareness/treatment seeking.

43. Early Onset  All use starts recreationally, but may lead to abuse.  Earlier the age of onset for gambling, the greater risk for a gambling problem (pathological gamblers in treatment report onset at 11 years).

44. BWI Airport, Across from Play Area

45. Who Is Most Likely To Play Poker?

46. Annenberg Surveys  2.9 million youth play cards in average week.  Monthly card playing jumped 20% to 42%.  580,000 between 14 and 22 gamble on Internet on a weekly basis.  44% of weekly gamblers report either preoccupation, over-spending, tolerance or withdrawal.

47. Does Normal Brain Development Encourage Gambling (& Other Risky Behavior) ? > risk taking (particularly in groups) > propensity toward low effort - high excitement activities < capacity for good judgment & weighing consequences > sensitivity to novel stimuli….

48. Adolescence is a period of profound brain maturation. Adolescence is a period of profound brain maturation. It was believed that brain development was complete during childhood It was believed that brain development was complete during childhood The maturation process is not complete until about age 24. The maturation process is not complete until about age 24.

49. Involvement in Addictive Behaviors Total useWeekly use Total useWeekly use 7th9th11th 7th9th11th Alcohol37%62%80% 7%14%20% Drugs 4%13%27% 3% 2% 9% Cigarettes18%35%48% 7%16%31% Gambling79%79%83%30%37%37%

50.  Kids have access to formal (credit cards), informal (bookies) and illegal (stealing) means of financing gambling.  Losses are “real” only when gambling stops, until then the problem gambler is just the next bet away from winning everything back.

51. Problem Gambling Chase Losses Truancy/ Delinquency Stealing Money Lying about Gambling Preference for Gambling Gamble to Escape Gambling Problems Family/ Peer Problems

52. The Good News: There is Hope and Help  While the majority of Americans gamble, most never develop problems.  A total of 3-4% of the general population will experience problems with their gambling in a given year.  PG often clusters with other problems.  PG is a treatable disorder, like all addiction most efficiently and effectively when detected early.

53. National Council on Problem Gambling 216 G Street, NE 2nd Floor Washington, DC 20002 Tel: 202.547.9204 Fax: 202.547.9206 Email: keithw@ncpgambling.org Web: www.ncpgambling.org