1. Gambling Treatment in Prisons Gambling Treatment in Prisons Jeff Marotta, PhD Oregon Problem Gambling Services Alberta Gaming Research Institute’s 6 th Annual Conference Banff, Alberta, March 30th, 2007

2. Why gambling treatment in prisons?

3. Gambling Treatment Anyone, Anyone... Problem gamblers are notorious for not seeking treatment  Less than 5% of problem gamblers report past involvement with a PG intervention  In Oregon, only 2.5% of the estimated current problem gamblers enter treatment each year.

4. Where have all the problem gamblers gone? Long time passing Where have all the problem gamblers gone? Long time ago Where have all the problem gamblers gone? Gone to prison every one When will they ever learn?

5. Quick Review of the Literature

6. Gambling and Crime Aborn & Bennett ( 2005).  Communities with casino gambling experience more crime than communities without Smith, Wynne, & Hartnagel (2003)  Gambling related crime was responsible for 2.7% of Edmonton police records in 2001. Meyer & Stadler (1999).  59.3% of the pathological gamblers admitted to having committed a crime during the last 12 months of gambling compared to 22.3 of comparative group National Gambling Impact Study Commission (1999).  A third of problem and pathological gamblers had been arrested, compared to 10% of low-risk gamblers and 4% of non-gamblers

7. Prison Prevalence Studies Abbott & McKenna (2005). NZN=94  33% female prisoners lifetime history of PG Abbott, McKenna, & Giles (2000). NZ N=357  31% of male prisoners lifetime history of PG Anderson (1999). Mid-West U.S. N=223  38% of male inmates lifetime history of PG Shaffer, Hall, & Vander Bilt (1999). Meta-analysis  Prison population highest prevalence of disordered gambling among all the population groups studied. Templer, Kaiser, & Sicsoe (1993). NV N=136  26% of male inmates lifetime history of PG

8. Prison Based Interventions Nixon, Leigh, & Nowatszki (2006).  Forty-nine inmates completed a six-session problem gambling awareness and prevention program over 18 months at the Lethbridge Correctional Facility in Alberta, Canada. Particularly effective in changing attitudes towards gambling. Reynolds (1999).  Integrated PG awareness program as a component of the chemical dependency treatment prisoners were already receiving in three Minnesota prisons. Bond (1998).  Integrated PG as a component of the chemical dependency treatment program in a British prison.

9. Oregon Gambling Evaluation and Reduction Program (GEAR) Corrections Component A Self-Help Manual For use in the Oregon GEAR program LLC

11. Project Objectives Assess problem gambling prevalence among Oregon’s incarcerated females Examine the relationship between gambling and criminal offending Determine demand for PG services among inmates Develop and evaluate problem gambling intervention for use within correctional facilities Reduce re-incarceration

12. Measurement Tools Problem Gambling Screen - Incarcerated  Adapted from Anderson (1999) SOGS, demographics, illegal activity inventory Pre-Post Intervention Questionnaire  Program satisfaction, risk and signs knowledge, knowledge of where to get help 6 & 12 month follow-up  Survey tool (self-report)  Criminal history update (public records)

13. Survey Findings N=378 38% problem or pathological gambler  27% probable pathological gambler (SOGS 5 +)  11% problem gambler (SOGS 3 or 4)  12% reported crimes related to gambling 19% reported to have a household member with gambling problem 3% previously received help for PG

14. Survey Comments by Inmates “I am so grateful this program has come to Coffee Creek – I need it desperately.” “I was able to recognize and admit my gambling problem.” “I have gambled so that I didn’t have to deal with my problem and because I liked it and still do.” “I did what I had to to get money to gamble.” “90% of my crimes were due to gambling, worse addiction I've ever had.”

15. GEAR - Inmate Intervention Adapted from the Alberta born self-help gambling manual:  D. Hodgins and K. Makarchuk, “Becoming a Winner: A Gambling Self-Help Manual” (2003).  Self-change guide utilizing cognitive-behavioral techniques Six 90 minute small-group psycho-educational classes

16. Manuals Available to the Public http://www.addiction.ucalgary.ca/ordertest.htm

17. Challenges Crossing cultures  Prison culture, agency cultures, mixed inmate populations Logistical considerations when working within a correctional facility Special data collection challenges  70% attrition rate at 6 month follow-up Poor rate of consent to be followed Difficulty locating participants

18. Client Demographics 87% Caucasian 52% female Average age 44 38% married 54% worked full-time Average education 13 yrs 27% drug/ETOH problem Video poker 69%, slots 14% 82% Caucasian 100% female Average age 37 14% married 29% worked full-time Average education 12 yrs 87% drug/ETOH problem Video poker 62%, scratch it 14% Prison PopulationGeneral Population

19. Did participants benefit?

20. Pre/Post Intervention Findings (N=170) Knowledge and attitude improved 1. PG can become an illnessns 2. PG is Treatablens 3. Treatment is available in ORp < 0.01 4. PG is accepted as a mental health issuep < 0.01 5. Its possible to find PG tx in ORp < 0.01 6. Asking for help is OKp < 0.05 7. You have to gamble every day to be a PGp < 0.01 8. People gamble for the same reasonp < 0.01 9. Goals are important to help PGp < 0.01 10. Gambling treatment is affordablep < 0.01

21. 6-Month Follow-up N=45 64% reported they had set goals regarding reducing or eliminating their problem gambling. Satisfaction levels with the helpfulness of the program where over 97% positive responses. Slightly over 12% reported current problems with problem gambling.

22. Changes in Problem Gambling (In Percent)

23. Summary

24. Take away points A large proportion of incarcerated persons have a history of a gambling problem Problem gambling appears to be a risk factor for re- incarceration Data supports problem gambling interventions in prisons and it makes sense The Oregon GEAR Corrections approach appears promising as a prevention strategy for incarcerated persons close to release.

25. Conclusion Alberta’s problem gambling work has far reaching impacts  thanks U of C and the Addiction Centre Further work is needed to explore the use and effectiveness of problem gambling minimal interventions within a corrections setting.

26. For more information contact : Jeffrey Marotta, PhD, CGAC II Problem Gambling Services Manager Oregon Department of Human Services 503-945-9709 Jeffrey.j.marotta@state.or.us

27. References Listed in appearance order Abbott, M. W., and McKenna, B. G. (2005). Gambling and problem gambling among recently sentenced women in New Zealand prisons. Journal of Gambling Studies, 21 (4), 559. Abbott, M. W., McKenna, B. G., & Giles, L. C. (2000). Gambling and problem gambling among recently sentenced males in four New Zealand prisons. New Zealand: Department of Internal Affairs. Anderson, Dennis. (1999). Problem gambling among incarcerated male felons. Journal of Offender Rehabilitation, 29, 113-127. Shaffer, H. J., Hall, M. H., & Vander Bilt, J. (1999). Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. American Journal of Public Health, 89(9), 1369-1376. Templer, D. I., Kaiser, G., & Sicsoe, K. (1993). Correlates of pathological gambling propensity in prison inmates. Comprehensive Psychiatry, 35, 347-351. Nixon, G., Leigh, G., and Nowatszki, N. (2006) Impacting attitudes towards gambling: A prison gambling awareness and prevention program. Journal of Gambling Issues. 15, 1-15. Reynolds, Kelly. (1999, March). Problem gambling prevention program for prison inmates. Beyond the Odds. Retrieved May 4, 2004, from http://www.miph.org/gambling/bto/mar99/1.htmlhttp://www.miph.org/gambling/bto/mar99/1.html

28. References Bond, Peter. (1998). The development of good practices and treatment in the rehabilitation of alcoholic and drug-addicted inmates in her majesty’s prisons. Alcohol & Alcoholism, 33, 83-88. Aborn, Richard and Bennett, John. (May 2005). Gambling: Who’s really at risk? The connection between gambling and crime. Constantine & Aborn Advisory Services: New York, NY Smith, Garry, Wynne, Harold, and Hartnagel, Tim. (March 2003). Examining police records to assess gambling impacts: A study of gambling-related crime in the city of Edmonton. Alberta Gaming Research Institute: Alberta, Canada. Meyer, G. & Stadler, M. A. (1999). Criminal behavior associated with pathological gambling. Journal of Gambling Studies, 13, 29-43. National Gambling Impact Study Commission. (1999, June). Gambling impact and behavior study. National Opinion Research Center at the University of Chicago. Hodgins, D., Currie, S, & el-Guebaly, N. (2001). Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69; 1, 50-57. Hodgins, D., Currie, S, el-Guebaly, N., & Peden, N. (2004). Brief motivational treatment for Pathological Gambling: A 24-month follow-up. Psychology of Addictive Behaviors, 18 ; 3, 293- 296.