1. Compulsive Gambling University of Detroit Mercy HLH 532 Julie Bruce Caroline Daneshvar Chasity Falls Heather Hatfield William Schram

2. Detroit, MI

3. Fun times…or troubled times?

4. More than just casinos…..

5. How many are affected? Over two and a half million adults are pathological gamblers and another three million are problem gamblers (Gerstein et al 1999). Percentage wise, problem gambling effects 1-3% of the population (Sharpe et al 1995)

6. The four types of gamblers Social gamblers Compulsive gamblers Professional gamblers Problem gamblers

7. The life of the problem gambler Received welfare Declared bankruptcy Having been arrested Divorce rates for pathological gamblers were 53.5%, problem gamblers were 39.5%, other gamblers 29.8%, and non-gamblers 18.2% (Gerstein et al 1999).

8. DSM-IV Diagnostic Criteria Preoccupation  Reliving past experiences  Handicapping  Planning next gambling trip Tolerance  More money = same excitement

9. DSM-IV Diagnostic Criteria Withdrawal  Unable to quit, cut back, or stop Loss of control  Restless or irritable when trying to quit Escape  Helplessness, guilt, anxiety, depression

10. DSM-IV Diagnostic Criteria Chasing  Returns to “get even” on losses Lying  Conceals gambling from family, others Illegal acts  Forgery, fraud, theft, embezzlement

11. DSM-IV Diagnostic Criteria Risked relationships  Personal relationships / marriage  Employment  Education Bailouts  Relies on others for money

12. Two Types of Gamblers Action seekers  Usually male  Competitive  Start at a young age  “Big tippers”  “High rollers”  Narcissistic personality Escape seekers  Female  Gamble for long hours  Late onset  Relationship issues

13. Study Comparison Problem Gamblers Help Network of West Virginia Gamblers Anonymous

14. Government Sponsored/Run Gaming Venues -VLT's in bars/restaurants -Daily Lottery and Powerball -BINGO and Tip Boards -Two horse race tracks with slots and VLT's -Two Dog Race tracks with Slots and VLT's

15. Solution First Choice Health Systems, Inc, established in 1995 as a statewide network of behavioral health providers, manages various state contracts Answered RFP in December 1999 to design and implement a statewide gamblers help program

16. The Current Program Basics Provide 30 hours of clinical training and continuing education to licensed counselors, social workers and psychologists Provide two hours of clinical supervision for these clinicians Provide outreach so that gamblers and their family can self-identify to the help-line Answer help line 24/7 by trained clinician

17. Outreach Brochures at race tracks Stickers on some slot machines at tracks Billboards Radio Newspaper ads Exhibits at Professional conferences

18. Outreach WVU Medical School Addictions Institutes WV Counseling Association Conference WV Psychologists Association conference WV Social Workers Association Conference WV Drug and Alcohol Counselors

19. Program Basics Offer Gamblers a free two-hour assessment (or consultations for family) within 30 miles of residence and 72 hours of call Mail all callers printed information Refer appropriate callers to GA, Gam-anon, and consumer credit Services Provide support for the creation of new Gamblers Anonymous and Gam-Anon meeting where needed

20. Program Basics Conduct six month and one year follow-up calls Share demographic and outcome data with West Virginia Lottery & West Virginia DHHR officials Exchange of info with clinician allows for accurate evaluation of progress and recommendation of other interventions/services

21. Components of Gambler’s Anonymous Founded in 1957 by two men struggling with obsession of gambling 20 Question survey 12 Step Recovery Program

22. Summary of Recovery Program Meetings which are peer driven Meetings provide fellowship and support Success built upon the person’s acknowledgement of their problem No fees for attending meeting-non-profit organization No discrimination Convenient-meetings are held several nights of the week

23. 12 Step Program 1. The individual must realize they are powerless over gambling 2. Come to believe that a Power greater than ourselves could restore us to a normal way of thinking. 3. Make a decision to turn our will over to the care of this power of our own understanding. These first 3 steps get the gambler in a mental frame of mind to approach recovery-spiritually sound

24. 4. Make a searching a fearless moral and financial inventory of ourselves 5. Admit to ourselves and to another human being the exact nature of our wrongs. 6. Be entirely ready to have these defects of character removed. The above steps require the individual to look at past wrongs and identify them. 7. Humbly ask God to remove shortcomings. 8. Make a list of all persons we have harmed and become willing to make amends to them all. 9. Make a direct amends to such people wherever possible, except when doing so would injure others.

25. Steps 7-9 guide the individual through the repair of all damage that gambling has caused. 10. Continue to take personal inventory and when wrong promptly admit it. 11. Seek through prayer and meditation to improve a conscious contact with God. 12. Having made an effort to practice these principles in all affairs, try to carry this message to other compulsive gamblers. The last three steps are maintenance steps, to be carried for the rest of the individual’s life. Daily inventory sheets are recommended to help the person to self-reflect on their progress

26. West Virginia Strengths - Free 24/7 hotline - 2-hr. assessment - Free consultation with a trained counselor for gambler & family (30 hrs.) - Check-ups (6 mo. & 1yr.) - Record keeping to determine how detrimental gambling is becoming Weaknesses - Consultation/assessment could be up to 30 miles away - Over the phone, no one-on-one interaction - An authority figure

27. West Virginia Improvements: - More contact time - Decrease time between follow-up calls - Counselors more readily available

28. Gamblers Anonymous Strengths - Free meetings - Available transportation - Weekly meetings on a variety of days, times, & locations - Peer support - Honesty - Pressure relieve meetings with a sponsor Weaknesses - Low success rate - High relapse rates - Not “therapy”

29. Gamblers Anonymous Improvements: - Intimate sessions amongst gamblers

30. Healthy People 2010 Goal: increase quality of life - Usually have no support - Wondering where to get money to support their addiction, shelter, eat

31. The Health Belief Model (HBM) Variety of Constructs: - Used to help gambler over-come addiction 1. Perceived susceptibility & severity – the notion that the gambler is in population to have an addiction behavior * at this pt. the gambler will reach out for help (Cues to Action) 2. Perceived threats – the thought of having no money 3. Perceive benefits – the idea that forgiveness will be given & all family & friend issues resolved 4. Self-efficacy – is needed & once in the life of gambler, he/she can work on continuing with their treatment & begin to set future goals

32. Outcomes-Effectiveness of GA Stewart and Brown(1988) describes difficulty in measuring: -no case histories kept (anonymity) -can’t get a representative sample b/o changing nature of attendees -self-selected membership leads to sample bias -no control group

33. Outcomes of GA Stewart and Brown(1988) -232 GA attendees 8% were abstinent after 1 year, 7% after two years -problem may be because of nature of program as a peer-oriented program, unable to provide special psychological needs -Argued that the most severe gamblers attend GA & need for individual therapy

34. Outcomes of GA Lesier and Blume(1991) -outcomes for patients in individual and group inpatient programs plus GA -Of 72 patients interviewed after 14 months, 64% achieved abstinence and gambling problems had decreased significantly -indication for simultaneous professional programs plus GA

35. Effectiveness of WV program 47% clients were able to be contacted -6 months after program, 57% were abstinent(43% were still gambling) -gambling related debt was significantly decreased in 19% of the abstinent group -68% of the 160 abstinent clients had completed initial assessment and referral

36. Effectiveness of WV -data is being collected on the # of people who go to first assessment, but also engage in therapy, but this data is not yet available.

37. References Cooper-Moran, Mia & Kruedelbach, N. The Problem Gamblers Help Network of West Virginia. 17th National Conference on Problem Gambling. June 19- 21, 2003. Ferentzy, P. & Skinner, W. (2003). Gamblers Anonymous: A critical review of the literature. The Electronic Journal of Gambling Issues. www.camh.netwww.camh.net Gamblers Anonymous Website. 2004. www.gamblersanonymous.orgwww.gamblersanonymous.org Gamblers Anonymous Brochures and Publications. October 2003. Gamblers Anonymous & Michigan Department of Community of Health presentation. University of Detroit Mercy. Monday, June 14, 2004. Glanz, K., Rimer, B.K., & Lewis, F.M. (2002). Health behavior and health education: Theory, research, and practice (3rd ed.). San Francisco: John Wiley & Sons, Inc. Healthy People 2010 (2004). A systematic approach to health improvement. www.healthypeople2010.gov www.healthypeople2010.gov Lesieur, H.R. & Blume, S.B. (1991). Evaluation of patients treated for pathological gambling in a combined alcohol, substance abuse, and pathological gambling treatment unit using the Addiction Severity Index. British Journal of Addiction, 86, 1017-1028. Stewart, R.M. & Brown, R.I.F. (1998). An outcome study of Gamblers Anonymous. British Journal of Psychiatry, 152, 284-288.