1. The Carolina Recovery Program of UNC Chapel Hill The Intersection of Gambling Disorders and Collegiate Recovery Programs Frank Allison Shane Phillips

2. The Carolina Recovery Program of UNC Chapel Hill Today’s presentation Defining Gambling and Problem Gambling (≠) Prevalence and Comorbidity What about the University? Collegiate Recovery Programs and Gambling Disorder Educational Resources Questions Moving Forward

3. The Carolina Recovery Program of UNC Chapel Hill What is gambling? Risking something of value on an activity or event in which the outcome is uncertain, in hopes of winning something of material value DSM 5, 2013

4. The Carolina Recovery Program of UNC Chapel Hill Common forms of gambling Internet/ Fantasy Sports Lottery – scratch off, Powerball, etc. Animal racing/ fighting Sports Games of skill (darts, bowling, etc.) Casino/ card games Stocks/ day trading Bingo

5. The Carolina Recovery Program of UNC Chapel Hill How have we talked about people with gambling problems? Gamblers as: Pathological Compulsive Obsessive Impulsive Addicts

6. The Carolina Recovery Program of UNC Chapel Hill Current language: Gambling Disorder DSM-5: “Gambling Disorder” Located under Substance Related and Addictive Disorders Criteria = four or more in a 12 month period Incorporates spectrum model of mild, moderate, severe

7. The Carolina Recovery Program of UNC Chapel Hill DSM-5 criteria Needs to gamble with increasing amounts of money in order to achieve the desired excitement Is restless or irritable when attempting to cut down or stop gambling Has made repeated unsuccessful efforts to control, cut back, or stop gambling Is often preoccupied with gambling (e.g., having persisted thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble) DSM 5, 2013

8. The Carolina Recovery Program of UNC Chapel Hill DSM-5 criteria continued Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed) After losing money gambling, often returns another day to get even (“chasing one’s losses”) Lies to conceal the extent of involvement with gambling Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling Relies on others to provide money to relieve desperate financial situations caused by gambling DSM 5, 2013

9. The Carolina Recovery Program of UNC Chapel Hill What’s the point? Money amount and frequency increases just as AOD tolerance increases Inability to stop…restless, irritable, and discontented when trying to stop Lying or otherwise causing harm in significant relationships, whether they be personal or professional

10. The Carolina Recovery Program of UNC Chapel Hill Gambling Disorder prevalence Lifetime prevalence overall population = 0.4% - 1.0% DSM 5, 2013

11. The Carolina Recovery Program of UNC Chapel Hill Gambling Disorder prevalence among college students Prevalence in overall college population = 5-10% Barnes, et al., 2010; Blenn-Pike, et al., 2006; Rinker, et al., 2015

12. OVERALL POPULATION 0.4%-1% COLLEGE POPULATION 5-10% MEN 0.6%11% WOMEN 0.2%2% CAUCASIAN 0.4%5% AFRICAN-AMERICAN 0.9%3.9% HISPANIC/ LATINO 0.3%3.8% ASIAN n/a7.9% The Carolina Recovery Program of UNC Chapel Hill Gambling Disorder prevalence comparison * Barnes, et al., 2010; Blenn-Pike, et al., 2006; DSM 5, 2013; Rinker, et al., 2015 *College population race/ ethnicity data is preliminary

13. The Carolina Recovery Program of UNC Chapel Hill Co-occurring/ comorbid Gambling Disorder and: Substance use Binge drinking High-risk sex practices Overeating/ binge eating Lower GPA Anxiety/ Depression Suicidal ideation/ attempts Kessler et al. 2008; Petry et al. 2005

14. The Carolina Recovery Program of UNC Chapel Hill Special topic: Internet and Daily Fantasy Sports Internet vs. Non-internet gamblers Greater comorbidity of gambling severity, substance use, and delinquency in internet gamblers Daily Fantasy Sports Students who participated in fantasy sports experienced higher rates of gambling-related problems Reality Fantasy Leclerc, et al., 2012; Martin, et al., 2014

15. The Carolina Recovery Program of UNC Chapel Hill The University and gambling - education and interventions Over half of persons with a Gambling Disorder report wanting to learn about problem gambling Best Practices: Brief motivational interviewing which incorporates personalized feedback A mixture of individual and group brief interventions Offer normative information about problem behavior – Social Norming Offer techniques to curb disordered gambling behavior Focus on improving social supports mechanisms Weinstock & Petry, 2008; Martens, et al. 2015

16. The Carolina Recovery Program of UNC Chapel Hill The University and gambling - What an effective gambling policy looks like University of Missouri Gambling Policy In compliance with local, state, and federal law, illegal or unlicensed gambling in any form (including sports wagering, sport/office pools, internet gambling and poker games) is prohibited on University property. See http://ago.mo.gov/publications/gambling.htm for more info from the Attorney General in Missouri.http://ago.mo.gov/publications/gambling.htm In accordance with the Acceptable Use Policy for Computing and Telecommunications Resources, students must use University computing recourses in a manner compliant with University Policies and State and Federal Law (B.1f), and must not use University computing resources for personal profit. This includes but is not limited to internet gambling and telephone based sports wagering. In accordance with fundraising guidelines for Student Organizations, unacceptable fundraisers include raffles, bingo or other forms of gambling. See http://www.getinvolved.missouri.edu for more info.http://www.getinvolved.missouri.edu Student athletes must adhere to all NCAA regulations regarding sports wagering. See http://web1.ncaa.org/dontBetOnIt/ for more information. http://web1.ncaa.org/dontBetOnIt/ http://wellness.missouri.edu/gambling/educators.html

17. The Carolina Recovery Program of UNC Chapel Hill The University and gambling - screenings The NODS-CLiP* Short Problem Gambling Screen: 1.Have there ever been periods lasting 2 weeks or longer when you spent a lot of time thinking about your gambling experiences or planning out future gambling ventures or bets? 2.Have you ever tried to stop, cut down, or control your gambling? 3.Have you ever lied to family members, friends, or others about how much you gamble or how much money you lost on gambling? Yes to 1 or more, further assessment is advised! Free program for College health professionals and administrators This brief survey allows college students to see how their gambling behavior compares with other students. – Social Norming - After the brief survey, students receive info comparing themselves to other students across the nation Part of comprehensive website provided by the National Center for Responsible Gambling College gambling.org Volberg, R. A., Munck, I. M., & Petry, N. M. (2011)

18. The Carolina Recovery Program of UNC Chapel Hill Inside or outside the University – mutual aid organizations SMART Recovery - CBT based 4 part program 1.Enhancing & Maintaining Motivation to Quit – Helps you identify and keep up with your reasons to stop gambling. 2.Coping with Urges – Dealing with urges is part of recovery. SMART has tools designed to help our members cope with urges. 3.Managing Problems –SMART Recovery participants learn problem-solving tools to help them manage challenges along the way. 4.Lifestyle Balance – SMART give members skills to help balance both short and long-term goals, pleasures and needs that were once out of balance. Gambling Anonymous 12 step based Cross talk actually encouraged Gam-Anon – family component International Hotline Online and in person meetings Financial Review process after 3 months of abstinence http://www.smartrecovery.org/addiction/gambling_addiction.html

19. The Carolina Recovery Program of UNC Chapel Hill Question - Who does this describe? Some individuals are impulsive, competitive, energetic, restless, and easily bored; they may be overly concerned with the approval of others and may be generous to the point of extravagance. At other times they are depressed and lonely, and express feelings of helplessness, or guilt. Up to half of these individuals in treatment have suicidal ideation, and about 17% have attempted suicide.

20. The Carolina Recovery Program of UNC Chapel Hill Why CRP’s should include Gambling Disorders Increased social support - Studies have shown that individuals who suffer from Gambling Disorder lack adequate social support Gambling and alcohol tend to go hand in hand- individuals who suffer from Gambling Disorder have high rates or co-occurring substance related disorders Individuals in recovery form Substance Use Disorders may start gambling for an adrenalin rush – Studies suggest that some individuals replace substance use with Gambling which can become disordered (SAMHSA) CRP’s provide recovery protection. Weinstock & Petry, 2008; Martens, et al., 2015

21. The Carolina Recovery Program of UNC Chapel Hill Educational resources BetOnU – College Gambling Survey BetOnU National Center for Responsible Gambling National Center for Responsible Gambling CollegeGambling.org

22. The Carolina Recovery Program of UNC Chapel Hill Questions moving forward: ARHE suggests having a community specific to recovery from substance use disorder, but states that each program needs to decide for itself. Other best practices suggest having an inclusive model which includes other disorders. Do you have to be abstinent from gambling? If so, how long of a period? How does it fit in with your definition of recovery? Can people who suffer from gambling disorders drink? Can other member students gamble then? What about card playing? What other disorders do you include in your CRP?

23. The Carolina Recovery Program of UNC Chapel Hill References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Barnes, G. M., Welte, J. W., Hoffman, J. H., & Tidwell, M. C. O. (2010). Comparisons of gambling and alcohol use among college students and noncollege young people in the United States. Journal of American College Health, 58(5), 443-452. Blinn-Pike, L., Lokken Worthy, S., & Jonkman, J. N. (2007). Disordered gambling among college students: A meta-analytic synthesis. Journal Of Gambling Studies, 23(2), 175-183. doi:10.1007/s10899-0069036-2 Hodgins, D., Mansley, C., & Thygesen, K. (2006). Risk factors for suicide ideation and attempts amongpathological gamblers. American Journal on Addictions, 15(4), 303–310. Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological medicine, 38(09), 1351-1360. Leclerc, D., Brunelle, N., Cousineau, M. M., Dufour, M., Gendron, A., & Martin, I. (2012). Internet gambling, substance use, and delinquent behavior: An adolescent deviant behavior involvement pattern. Psychology of addictive behaviors, 26(2), 364. Martens, M. P., Arterberry, B. J., Takamatsu, S. K., Masters, J., & Dude, K. (2015). The efficacy of a personalized feedback-only intervention for at-risk college gamblers. Journal of consulting and clinical psychology, 83(3), 494. Martin, R. J., & Nelson, S. (2014). Fantasy sports, real money: Exploration of the relationship between fantasy sports participation and gambling-related problems. Addictive behaviors, 39(10), 1377-1382. Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV Pathological Gambling and Other Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions.[CME]. The Journal of clinical psychiatry, 66(5), 1-478. Rinker, D. V., Rodriguez, L. M., Krieger, H., Tackett, J. L., & Neighbors, C. (2015). Racial and Ethnic Differences in Problem Gambling among College Students. Journal of Gambling Studies, 1-10. Substance Abuse and Mental Health Services Administration http://store.samhsa.gov/shin/content//SMA14-4851/SMA14-4851.pdf Weinstock, J., & Petry, N. M. (2008). Pathological gambling college students’ perceived social support. Journal of college student development, 49(6), 625. Volberg, R. A., Munck, I. M., & Petry, N. M. (2011). A quick and simple screening method for pathological and problem gamblers in addiction programs and practices. The American Journal on Addictions, 20, 220–227.