ms bridgitte thornley - gp cme north/sat_room10_1400_thornley...problem gambling foundation of nz,...

Ms Bridgitte ThornleyNational Director

Counselling Services

Problem Gambling Foundation

Christchurch

14:00 - 14:55 WS #158: Problem Gambling

15:05 - 16:00 WS #170: Problem Gambling (Repeated)

Problem Gamblingis a Health Issue

Bridgitte Thornley

National Director PGF Services

PGF Group

PGF Services, Asian Family Services,and Mapu Maia (Pasifika service) are part of the

Problem Gambling Foundation of NZ, trading as PGF Group

Introduction

Topics discussed today:

• Prevalence of gambling harm

• Pokie participation

• Gambling Harm and co-existing problems

• Case Studies

• Screening

• Summary and questions

Australian Medical Association recommendations:• GP’s should be aware of gambling harm impacts on

physical and mental health• 1 in 50 patients will turn up to GP clinics specifically

due to health problems as a result of their gambling• GP’s should include a gambling risk assessment when

taking a medical history• A shared-care approach to case manage people with

gambling problems and their families • Information kits that include screening questions

should be available to all GP’s• Medical education should include recognition of

gambling as a health issue

Definitions of harmful gambling

The Ministry of Health defines harmful gambling as:

“Patterns of gambling behaviour that compromise, disrupt or damage health, personal, family or vocational pursuits.”

The Gambling Act 2003 defines a harmful gambler as:

“A person whose gambling causes harm or may cause harm.”

NZ National Gambling Study 2018

25%

68%

4.60%1.80%

0.20%

No gambling No risk Low risk Medium Problem Gambling

Moderate-risk/problem gamblers

2.0%1.2%

0.9%

8.6%

7.6%

New Zealand total Asian European/Other Maori Pacific

Low-risk gamblers

4.6% 4.5% 4.1%

6.4%

8.8%

New Zealand total Asian European/Other Maori Pacific

Over 5,000 gamblers sought treatment in 2017/18

Source – MoH Draft Strategy to Prevent and Minimise

Gambling Harm 2019-20 – 2021-2022)

39.30%

31.00%

21.20%

8.50%

56.10%

European/Other Maori Pasifika Asian Men

The majority of harm is caused by pokies

Primary gambling mode2017/18

Why are pokies so harmful?

• Continuity

• Speed

• Random reinforcers

• Illusion of skill

• Solitude

• Chasing losses

• No more than 8% of New Zealanders use pub pokie machines at least once a year

• 2.2% of adults use a pokie machine in a pub once in a month or more

• Of these people, 50-60% experience gambling harm

• $770m lost in pub pokies equates to $9,625 per year each for the approx 80,000 people (over 18 years) who regularly play pub pokies

• The median income in South Auckland is $19,700 per year

Pokie participation

Population whom play pokies

Risk factors

Source: Abbott, M., Bellringer, M., & Garrett, N. (2018). New Zealand National Gambling Study: Wave 4 (2015). Report number 6. Auckland: Auckland University of Technology, Gambling and Addictions Research Centre.

RISK

FACTORS

ETHNICITY

GAMBLING AT

LEAST

MONTHLYGAMBLING

$50 OR

MORE

MONTHLY

POKIES

PSYCHOLOGICAL

DISTRESS

EXPERIENCE

OF

DEPRIVATION

Factors at play…

Gambling Products

GamblerEnvironmentImpulsivity

Distress

Reward pathway

Learnt behaviour

Belief in luckLegislation

Venue

Availability

Deprivation

Continuous play

Near misses

LDWs

Gambler’s fallacy

Illusion of skill

General harms of gambling

Coexisting problems with gambling harm presentations

50.6%

29.2%

57.0%

31.4%28.8% 32.0%

Drinking hazardouslyAlcohol dependantSmokersDrug useCo-existing Anxiety/DepressionSuicidal attempts

Gambling and Mental HealthKessler 2008; Zimmerman 2006; Korman 2008; Cunningham-Williams 2007; Petry 2005

Gambling harm compared to other health states

Gambling weighed against other harms

Gambling harm and family violence

Ministry of Health. (2017). Problem gambling and family violence in help-seeking populations: co-

occurrence, impact and coping. Ministry of Health Manatū Hauora.

Every door is the right door

AOD Problem Gambling

Mental Health

Case Study 1

• Male; 70yrs; European • Ex officer in the Army; PTSD• Managed by Veterans services Medication

• Zopaclone, antidepressants and Antibuse

Gambling on pokies at pubs and casinoTreatment

• 3 years counselling• Psychiatrist for PTSD

2 major relapses on gambling and alcoholDebt: $20,000 current (previous loss of business)

Case Study 2

• Female; Māori; 63yrs;

• Cleaner; lives with flatmate; partner chronic alcoholic

• Daily use of cannabis and alcohol

• Gambling 15 years – pub pokies

• Behind in rent, power and living hand to mouth each week

• Previous 3 yr jail term for fraud of elderly in her care

• Depression – no medication

• Treated for cancer

Addressing the issues together

Gambling

Mental Health Substance addictions

96% of people experiencing gambling harm don’t seek help … what would help?

Screening and ongoing conversations that ensure gambling & associated risks become a part of everyday assessing in all health services…

Do you sometimes feel unhappy or worried after a session of gambling?

No Yes

Does gambling sometimes cause your problems?

No Yes

Affected by another person’s gambling

Best practice to reduce harm

• Comprehensive assessment and screening

• Case formulation and intervention planning

• 3 main triggers; money, time and access

• Self-exclusions

• Secure their access to money

• Education and counselling

• Facilitations to other services

• Support groups

People who have lived with harmful gambling tell us …

“I spent my pension now I have no money for food or rent”

“The drunk is drunk, the stoner is stoned, gambling is a hidden disease”

“It’s unexplainable “

“It’s all consuming”

“What do you mean we can’t pay the rent this week?”

“Others have no understanding, how can they, we don’t understand ourselves”

“I felt more at risk of killing myself from gambling than I ever did with alcohol or drugs”

Summary:

• Those most at risk of gambling harm are more likely to be disadvantaged, have multiple stressors in their life, and have higher exposure to hazardous forms of gambling

• Moderate to high risk gamblers are people from the most deprived population

• Low risk gamblers also experience high deprivation and distress in their lives, have fewer strategies to reduce the harm and are likely to move into the moderate to high risk categories

Summary continued

▪ Low risk gamblers may gamble as little as once a month and spend from $50 a month

▪ Medium risk/problem gamblers gamble once a week or more and spend from $100 a month

▪ Substance use, substance use disorders and behavioural addictions are robust predictors of problem gambling onset

▪ Other factors implicated in problem development include psychological distress, recent major life events, childhood negative experience including trauma and abuse, low intelligence, and cognitive distortions regarding gambling

PGF Services:

• National service 13 offices from Auckland to Dunedin

• Face-to-face, skype, phone, and email counselling

• For gambler and/or affected others

• Free service and can self refer or via our website

• Education and Public Health Promotion

• Special library, fact sheets and research help

• Resources/brochures in a wide range of languages

• www.pgf.nzfor more information and referral form