1. Oregon Gambling Treatment System Jeff Marotta, PhD Problem Gambling Services Manager Alberta Gaming Research Institute’s 6th Annual Conference Banff, Alberta March 31, 2007

2. Gambling treatment in the context of emerging evidenced based practices. This presentation will offer the Oregon experience in piecing the puzzle together: Identifying challenges Employing strategic models Overview of the Oregon treatment system Viewing system measures

3. 158,337 square KM Population 3,690,505 – 2006 Major Industries - timber, paper products, farming (wheat, cattle), mining (coal), computer equipment, electronics

9. Oregon Gambling Expenditures (2005) $1.3 billion* In 1986 this figure was $95 million Source: Eco Northwest, 2007 http://www.econw.com/

10. Oregon Gambling: Summarized Oregon has more forms of legalized gambling and offers easier access to gambling than almost any other U.S. state - AND - Oregon is a nationally recognized leader in prevention, harm reduction and treatment for gambling problems Source: National Ctr for the Study of Gambling, 2006

12. Efforts to Address Problem Gambling 1% of Lottery revenues dedicated to a Gambling Treatment Fund administered by DHS

13. Designing a treatment system in a young field. Challenges: There have been few gambling treatment outcome studies. Therefore, data to date may not represent the full spectrum of recovery modes. Few randomized clinical trials in PG treatment research - meaningful comparisons across treatments difficult. Unclear how different subgroups of PGs, including comorbidity profiles, respond to different treatment approaches

14. Where to start Without a menu of evidenced based treatments must rely on theory driven and monitored approaches – Philosophical Models – Surveillance and feedback systems – Flexible design structure to respond to data driven performance measures

15. Strategic Plan: Oregon Problem Gambling Services Released September 19, 2000 Influenced by: – Stepped-care approach to treatment Sobell & Sobell (1999) – Public health approach to gambling Korn & Shaffer (1999) Oregon Problem Gambling Services

16. A Stepped Care Approach Treatment should be individualized. The treatments selected should be consistent with the contemporary research literature. The recommended treatment should be least restrictive but still likely to work. Sobell, M.B., & Sobell, L.C. (1999). Stepped care for alcohol problems: An efficient method for planning and delivering clinical services. In J.A. Tucker, D.A. Dovovan, & G.A. Marlatt (Eds.), Changing addictive behavior: Bridging clinical and public health strategies (pp. 331-343). New York: Guilford Press. Three fundamental principles of health care (Sobell & Sobell, 1999)

17. Public Health Approach (Korn & Shaffer, 1999). Adoption of strategic goals for gambling preventing gambling-related problems protecting vulnerable groups promoting balanced and informed attitudes, behaviors, and policies Endorsement of public health principles prevention is a community priority, with appropriate allocation of resources incorporating a mental health promotion approach fostering personal and social responsibility for gambling policies and practices Adoption of harm reduction strategies. healthy-gambling guidelines for the general public vehicles for early identification flexible treatment goals surveillance and reporting systems Allocation of resources to identify and treat level 2 gamblers. Korn, D., & Shaffer, H. (1999). Gambling and the health of the public: Adopting a public health perspective. Journal of Gambling Studies, 15, 289–365.

18. System Components Treatment Prevention and outreach Quality control and evaluation Workforce development Partnerships

20. Treatment Continuum of Care – Gambling Evaluation and Reduction Program (GEAR) – Corrections Program – 27 outpatient treatment centers – 3 crisis-respite programs – 1 residential treatment program

22. Oregon Problem Gambling Help Line (05-06): 2,129 calls for help 93% resulted in referrals for service

23. Gambling Treatment in Oregon: An Evidenced Based Process

24. Evidenced Based Process Program development is data based and systematically monitored Less concern about component analysis Focus on outputs and outcomes Require programs to adapt and develop their approach to optimize outcomes

25. Quality Improvement Report

26. Gambling Treatment Enrollments. Source: Moore & Marotta, in press

27. Demographics of Gambling Treatment Centers Participants in Oregon Total clients: 1,714 Gamblers / 345 Clients in Family Programs Gender, Gambler Clients Males 47.4% Females 52.6% Gender, Family Clients Males 33% Females 67% Average Age 44.6 years Average Household Income $36,495 Race/Ethnicity White 87% Marital Status Married 36% Divorced 25.5% Primary Locations for Gambling Lottery retailer (video) 69.9% Casino 17.3% Primary Gambling Preference Video poker 69% Slot machines 14% Cards 7% Average Gambling-Related Debt $ 23,331 Source: Moore & Marotta, in press

28. System Evaluation Results Treatment is working – 81% of clients reported either no gambling or reduced gambling at 6-months post-treatment 1 The system is working: – Oregon is one of the few states that appears to have averted a significant increase in problem gambling prevalence while expanding legalized gambling 2 1.Moore & Marotta, in press 2.National Center For the Study of Gambling, 2006.

29. Putting it all together We need more work to establish evidence based approaches, in the meantime, data driven processes can and must make do!

30. Thank You Further information can be found at: http://www.oregon.gov/DHS/addiction/gambling.shtml Or contact: Jeff Marotta, PhD Problem Gambling Services Manager Oregon Department of Human Services Addictions and Mental Health Division 503 945-9709 jeffrey.j.marotta@state.or.us