1. 1 Problem Gambling Training John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

2. What is Gambling? 2 Gambling is risking something of value on an event that is determined mostly by chance. A person is gambling if he or she puts up something of value, such as money or property The outcome has an element of chance beyond the person’s control Once the bet is made, it’s not reversible John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

3. Types of Gambling Activities 3 Lottery and lottery scratch offs Pull-tabs and raffle tickets Bingo Sports betting Slot machines/VLT’s Card and table games Internet/sweepstakes cafes Horse betting Internet gambling- poker, bingo sites Stock market speculation Betting on other games-pool, bowling etc. Other? John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

4. 4 John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

5. 5 How big is Gambling? # ONE –Entertainment/ Leisure activity in USA Grosses $84,000,000,000 (84 BILLION) How much profit was there on Bingo in 2009? John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

6. Bingo! 6 $142,100,000 in profits John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

7. Gambling behavior Occurs on a continuum – is not static No Gambling E xperimentation Social At-RiskProblemPathological Level 1 Level 2 Level 3 John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

8. Comparison of CD and Gambling Tolerance 8 Chemical Dependency Tolerance, as defined by either of the following: o a need for markedly increased amounts of the substance to achieve intoxication or desired effect o markedly diminished effect with continued use of the same amount of substance. Pathological Gambling needs to gamble with increasing amount of money in order to achieve the desired excitement. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

9. Comparison of CD and Gambling Withdrawal 9 Chemical Dependency withdrawal, as manifested by either of the following: o the characteristic withdrawal syndrome for the substance o the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms. Pathological Gambling is restless or irritable when attempting to cut down or stop gambling John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

10. Comparison of CD and Gambling Loss of control 10 Chemical Dependency o the substance is often taken in larger amounts or over a longer period than was intended o there is a persistent desire or unsuccessful efforts to cut down or control substance use. Pathological Gambling: repeated unsuccessful effort to control, cut back, or stop gambling. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

11. Comparison of CD and Gambling Preoccupation 11 Chemical Dependency A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. Pathological Gambling is preoccupied with gambling … John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

12. Co-Occuring 12 Among pathological gamblers, alcohol has been found to be the most common substance of abuse. At minimum, the rate of problem gambling among people with substance use disorders is four to five times that found in the general population. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

13. Screening and Treatment 13 SOGS- South Oaks Gambling Screening Widely used, available, easy to use NODS-based on DSM IV criteria Lie/Bet- 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? John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

14. Screening and Treatment 14 Motivational Interviewing-meet client where they are at. CBT-magical thinking, belief systems GA Harm Reduction John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

15. Screening and Treatment 15 Currently listed as Impulse Control Disorder in DSM IV The DSM V will move gambling to the addiction section, it will be the only process disorder, (not involving substance) in this section. John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

16. Risk Factors 16 Significant financial loss Higher rates of relationship and family breakdown Higher rates of emotional and health problems Work-related difficulties Legal problems Higher rates of suicide John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

17. Risk Factors …suicide 17 Among those with gambling problems: 38% suicidal ideation (SI) 32% suicide attempt SI leads to more gambling when gambling SI+ PG = 5x more likely to have depression PG + Drug history = 6x more likely attempt 21% of attempters say it is gambling related Hodgins et al 2006 John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

18. Risk Factors …medication 18 Compulsive gambling problems as side effect of medication for Parkinson’s & Restless Leg Syndrome John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

19. Risk Factors …Mental Illness 19 Depression PTSD/TBI Mania Obsessive- Compulsive Disorder ------------------------------- also Grief/Loss John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

20. What to look and listen for 20 Listen: There goes the rent/car payment’ ‘If I go home my wife is going to kill me’ ‘I would be better off dead’ Look: Not eating Not going to the restroom Same clothes/grooming Gut feeling John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

21. Self Exclusion/Restriction 21 Some might not know about this option, customer has ability to voluntarily exclude themselves Urge to gamble significantly reduced Perception of control increased Intensity of negative consequences from gambling decreased John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

22. Self Exclusion/Restriction 22 Some might not know about this option, customer has ability to ask for restrictions Check cashing Credit John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

23. 23 Statewide Initiative Ohio Lottery Commission (OLC) Ohio Casino Control Commission (OCCC) Ohio State Racing Commission Ohio Department of Drug and Alcohol Addiction Services (ODADAS) www.org.ohio.gov John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

24. Problem Gambling Helpline 24 1 800 589 9966 Statewide Resource In operation since 1990 Continuously Updated Printed on Ohio Lottery tickets/materials Gaming Advertising Ohio for Responsible Gambling website www.org.ohio.gov www.org.ohio.gov John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director

25. Questions? 25 Scott Anderson ODADAS (Treatment) scott.anderson@ada.ohio.gov 614-466-8562 Melinda Norman ODADAS (Prevention) melinda.norman@ada.ohio.gov 614-644-8318 John R. Kasich, Governor Orman Hall, ODADAS Director Tracy Plouk, ODMH Director