1. PROBLEM GAMBLING As a CO-OCCURRING DISORDER 2007 Co-Occurring Disorders Conference October 1-2, 2007 Linda Graves Problem Gambling Program Manager Division of Alcohol and Substance Abuse

2. DSM-IV criteria Pathological Gambling 312.31 A.PERSISTENT AND RECURRENT MALADAPTIVE GAMBLING BEHAVIOR AS INDICATED BY AT LEAST FIVE OF THE FOLLOWING: 1.Is preoccupied with gambling 2. Needs to gamble increasing amounts of money in order to achieve the desired excitement 3. Has repeated unsuccessful efforts to control, cut back, or stop gambling

3. 4.Is restless or irritable when attempting to cut down or stop gambling 5.Gambles as a way of escaping from problems or of relieving a dysphoric mood 6.After losing money gambling, often returns another day in order to get even 7. Lies to family members, therapist, or others to conceal the extent of involvement with gambling DSM-IV criteria Pathological Gambling 312.31

4. 8.Has committed illegal acts, such as forgery, fraud, theft, or embezzlement, in order to finance gambling 9.Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling 10.Relies on others to provide money to relieve a desperate financial situation caused by gambling B. THE GAMBLING BEHAVIOR IS NOT BETTER ACCOUNTED FOR BY A MANIC EPISODE.

5. pathological gambling and substance use disorders Alberta, Canada (Bland, Newman, Korn and Stebelsky, 1993) General population study –20% of non-gamblers identified themselves as having a substance abuse disorder –Over 50% of those identified as pathological gamblers by the survey also had a substance use disorder

6. Texas--Feigelman, Wallisch, and Lesieur (1998) Among all respondents that were problem or pathological gamblers, 1/3 also had a substance use problem Feigelman et al (1998) also explored the converse situation. Among respondents who had a substance use disorder, 20.1% also had a gambling problem pathological gambling and substance use disorders (2)

7. National study, Petry, Stinson, and Grant (in publication) Found a strong association between alcohol and gambling disorders. Rates of alcohol abuse or dependence at four or more times higher among individuals identified as having a gambling disorder compared to those without the gambling disorder pathological gambling and substance use disorders (3)

8. In most cases, substance use disorders were in the past, not current with gambling disorders. Connecticut, clients seeking treatment for gambling problems, about 10% reported current illicit drug use or regular heavy use of alcohol. pathological gambling and substance use disorders

9. IMPORTANT NOTE: Treatment seeking gamblers with a history of substance use disorders tend to have –More severe gambling problems –Psychiatric symptoms –Other psychosocial difficulties Than gamblers without histories of substance use problems (Petry, 2004) pathological gambling and substance use disorders

10. Ladd and Petry (2003) Compared the 31% of gamblers with substance abuse histories with the remainder without such histories. More years of gambling problems More frequent gambling activity More likely to be receiving tx for mental health problems Reported greater psychiatric distress than gamblers without prior substance abuse problems. pathological gambling and substance use disorders

11. Langenbucher et al.(2001) In a mixed sample of substance abusers, Higher nicotine dependence scores More frequent use of alcohol More alcohol and other drug dependence symptoms In the pathological versus the non- pathological gamblers pathological gambling and substance use disorders

12. Smart and Ferris (1996) 41.6% of heavy gamblers were smokers 30.1% of recreational gamblers were smokers 21.3% of non-gamblers were smokers This study is 11 years old. pathological gambling and nicotine use

13. pathological gambling and other psychiatric disorders Mood disorders and suicidality Is the client depressed because of his or her gambling? OR Is the client treating a mental health problem by self-medicating with gambling?

14. Petry, Stinson, and Grant (in publication) 43,000+ surveyed 195 pathological gamblers 49.6% had lifetime prevalence of any affective disorder Compared to 18.5 % in non-gamblers pathological gambling and other psychiatric disorders 37% of pathological gamblers had major depression Compared to 12.3 % of non-gamblers 22.8% of pathological gamblers had bipolar disorder Compared to 2.5% of non-gamblers

15. College students and suicide Ladouceur, Dube’, and Bujold (1994) 1471 college students 26.8% of pathological gamblers had attempted suicide compared to 7.2% who were not pathological gamblers. Many studies report high rates of suicide ideation and suicide attempts in gamblers. pathological gambling and other psychiatric disorders

16. Anxiety disorders The research is not conclusive regarding anxiety disorders being elevated among pathological gamblers. Studies can be shown that indicate no higher rates than among the general population (Ibanez et al, 2001; Blaszczynski and McConaghy, 1989) while others show high rates of generalized anxiety disorders (Black & Moyer, 1998; Specker, 1996, and others) pathological gambling and other psychiatric disorders

17. Studies have been done regarding OCD and PTSD. The numbers in the studies were very small, and have not been replicated, so further research is needed before any conclusions can be drawn. This is also true for other psychotic disorders. If studies exist at all, the sample sizes are too small to draw conclusions. pathological gambling and other psychiatric disorders

18. So... What can we learn from all of this?

19. Research presents enough data to show both clients with substance use disorders and mental health disorders need to be screened for gambling problems. CONCLUSION?

20. But you might say... I CAN’T DO ONE MORE ASSESSMENT. I HAVE TOO MUCH TO DO ALREADY! I DON’T HAVE TIME. I DON’T KNOW HOW. Just LEAVE ME ALONE!! I DON’T want to know if they have another problem.

21. TWO THINGS: THAT’S ALL IT TAKES 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?

22. Help your client make a call to get help if they answer affirmatively to either of the two questions. 1-800-547-6133 24/7 Live voice response 24 hrs a day Will send literature Offer resources in caller’s area Will offer locations of GA meetings

23. Problem Gambling Treatment Provider Locations Bellingham (2) Burlington (3) Mt. Vernon (8 ) Tulalip( 16) Montesano (7) Olympia (9) Skokomish (11) Spokane (12) Tumwater (17) Vancouver (18) Yakima (19) See Map Inset Of Puget Sound Area

24. Bellevue (1) Kent (4) Kirkland (5) Renton(9) Seattle (10) Sumner (13) Tacoma (14) Tukwila (15) INSET MAP Lakebay (6)

25. 12. Spokane: Camas Institute Behavioral Health Services, 509-456-0799 Henry Montgomery, Ph. D. 509-744-0778 youth and adults New Horizon Counseling Services 509-838-6092 ext. 32 13. Sumner: The Center 253-863-0682 ext. 2 youth and adults 14. Tacoma: Metropolitan Development Council (The Center) 253-593-2740 youth and adults Tahoma Counseling Services 253-572-5035 Dr. Carmela Washington-Harvey youth and adults 253-852-3666 15. Tukwila: Seattle Mental Health 800-828-1449 youth and adults 16. Tulalip/ Everett: Tulalip Tribes Family Services 360-651-4400 17. Tumwater: A Healthy Risk 360-352-1052 18. Vancouver: Community Services Northwest Northwest Recovery Center 360-397-8488 ext. 7915 19. Yakima: Center for Counseling and Psychotherapy, LLC 509-966-7246 Triumph Treatment Services 509-248-1800 Publicly Funded Treatment July, 2007 Page 2

26. Publicly Funded Treatment July, 2007 1. Bellevue: Coastal Treatment Services 425-646-4406 youth and adults Consejo Counseling 425-746-4512 Spanish and English Youth Eastside Services 425-747-4937 adolescents 12-20 years old 2. Bellingham: Verry-Uhl Associates (360) 676-4999. 3. Burlington: Follman Agency 360-755-1125 Youth and adults 4. Kent: Dr. Carmela Washington-Harvey 253-852-3666 youth and adults Seattle Mental Health – Kent youth and adults 800-828-1449 5. Kirkland: Youth Eastside Services 425-747-4937 adolescents 12-20 years old 6. Lakebay (Key Peninsula):.Key Counseling 253-884-4860 7. Montesano: A Healthy Risk 360-249-2297 8. Mt. Vernon: Phoenix Recovery Services 360-848-8437 youth and adults 9. Renton: Donna Whitmire 425-227-0447 10. Seattle: Asian Counseling and Referral Services 206-695-7511 11. Skokomish/Shelton: Skokomish HOPE Alcohol & Drug Program 360-426-7788 ext. 200 Spanish and English youth and adults, All are Welcome!

27. Linda Graves Problem Gambling Program Manager gravell@dshs.wa.gov 360-725-3813